Patient in cath lab with doctor looking on
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Dissolving Stents: A Better Option for Patients With Coronary Artery Disease?

 

Abbott Laboratories’ new dissolving stent has created a buzz in the medical community and promises to be a boon to patients and the company’s bottom line. But does it live up to all the hype?

Overview

  • FDA approves dissolving stents
  • The pros and cons
  • Stent overuse
  • Getting second opinions

The stent, called Absorb, was approved by the FDA in July making it the first and only fully dissolving heart stent approved for use in the United States. Globally, more than 125,000 people with coronary artery disease have received it. Still, its effectiveness in preventing deaths and heart attacks is not quite what some had hoped for.

The pros

Up until now, stents were little wire mesh tubes inserted into blocked arteries to open them up and restore blood flow to the heart. They’re life savers if the blood supply to your heart is restricted by plaque. But they do have their drawbacks. Once implanted, they can’t be removed. And being made of metal, they’re somewhat rigid. This means your artery can’t expand and contract with normal changes in blood pressure. Over time, this may cause blood clotting. There’s also the slight possibility that scar tissue will form, once again blocking the artery.

The Absorb stent is made of a naturally dissolving polylactic acid, similar to dissolving sutures. They’re broken down by the water in your body and are completely gone within three years. The good news is that after they’ve dissolved, your artery returns to its natural state, expanding and contracting normally. Absolutely nothing is left behind, and the potential of future blockages is reduced. Or is it?

The cons

Based on a study published in the New England Journal of Medicine and Abbott’s own study submitted to the FDA, the dissolving stents work just as well as the metal type in preventing deaths and heart attacks; but not necessarily better. In fact, those getting the Absorb stents experienced slightly more blood clotting than those with the standard metal stents – 1.4 percent versus 0.7 percent.

I know. Statistically speaking, that’s not a big deal. Still, it’s not exactly the tremendous leap forward that many were hoping for. But with heart disease being the leading cause of death in the U.S., it’s a step in the right direction. Just know that any new technology will have its issues, and dissolving stents are no exception. For instance, to achieve the same radial strength as a metal stent, the polymer-based Absorb is a bit thicker, making it more problematic in arteries narrower than 2.5 millimeters. So before embracing this new technology, make sure it’s right for you. And while you’re at it, make sure you need a stent.

Too much of a good thing

There’s a growing concern that stents are overused. Sure, for heart attacks they’re vital. In fact, the evidence is so strong that stents save the lives of heart attack victims that hospitals equipped to perform the procedure are penalized if a stent isn’t placed within 90 minutes of a patient’s arrival in the ER. But not all stents are necessary, whether they dissolve or not. About 76 percent of patients with stable heart disease receive stents when medication may be enough. Considering the procedure can cost about $30,000, and in rare cases may cause tears in blood vessel walls, major bleeding, and other nasty complications, a second opinion may be in order.

Two heads are better than one

I know what you’re thinking. “Isn’t this insulting to my doctor?” Absolutely not. Most doctors are very supportive of this and may even encourage it. If your doctor objects, that’s a big red flag. Definitely get a second opinion.

So how do you go about it? Ask other heart patients about their doctors, or call a nearby medical center or medical school. The website Castle Connolly Top Doctors is also a good resource. It surveys doctors to see who they would go to within their own specialty. But a word of caution. A recommendation from your doctor may not be in your best interest. In all likelihood, it will be a friend or colleague. And be honest. Would you contradict your friend? Get an objective opinion. Then, if necessary, you can consider the stent most appropriate for you.