- The Washington Times - Thursday, March 28, 2002

From combined dispatches
BOSTON When doctors insert a mesh tube into an artery after unclogging it with a tiny balloon, they significantly reduce the chance that the artery will close up again, according to research published in today's New England Journal of Medicine.
Researchers found that 11.3 percent of the reopened arteries became blocked once again after six months. But if the doctors also implanted the mesh tubes, called stents, the blockage rate was only 5.7 percent.
"All of the data at 6 months hold up at 12 months," said the chief author of the international study, Dr. Gregg Stone of the Lennox Hill Heart and Vascular Institute in New York.
Although use of the stents did not increase the survival rate, "this study will set a new standard" for doctors trying to reopen arteries when the blockage has led to a heart attack, according to an assessment by the editors of the Journal.
They agreed with the Stone team that when a medical center has the equipment and doctors, stent implantation "should be considered the routine" for treating many heart attacks.
"You're talking an extra $1,000 to do the stent procedure," said Dr. Stone, characterizing it as a bargain compared with the cost of treating a patient when an artery clogs up again.
Drs. Richard Lange and David Hillis of the University of Texas Southwestern Medical Center in Dallas, said the real benefit of stenting "is relatively small" because it reduces the rate of blockage by only 6 percentage points. In addition, the benefits could fade as time passes.
In their commentary in the Journal, the two cautioned it also remains to be seen if stenting is the best treatment when clogging occurs in smaller arteries, or arteries that have been transplanted to the heart during bypass surgery.
Most heart attacks occur when one of the major arteries supplying blood becomes blocked, then the surrounding vessel walls rupture and a clot forms and totally blocks blood flow to the heart muscle.
Doctors have a six-to-12-hour window to get the passageway open before severe, permanent damage is done to the heart.
Most frequently, they use clot-busting drugs to remove the obstruction, although the drugs don't always work.
About 20 percent to 25 percent of heart-attack patients are treated with balloon angioplasty, in which a catheter with a balloon over its end is inserted into the artery and then inflated at the blocked point to clear the clot.
More than 2,000 heart attack victims at 76 medical centers in nine countries were tested in the Stone study.
Meanwhile, medical researchers are testing a new generation of stents that are coated with chemicals to prevent clogging, and preliminary findings suggest that the coating works in virtually every case.
Dr. Stone said about 1.1 million people worldwide had at least one stent implanted in 2000. The number is expected to jump to 1.8 million by 2005.
The Stone team also studied whether injecting patients with the drug abciximab, distributed under the brand name ReoPro by Eli Lilly and Co., made the balloon or stenting treatments more effective. They found it did not.
Lilly and Guidant Corp., which made the stents used in the study, paid for the research.


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