Fail-Safe Heart Procedure, The nytimes.com
[ Good job on that one, Mike, and thanks for stopping by. The good gray Times also picked up on it, see #reply-18497118 .In return, here's an older story you might find of some personal interest. ]
A study published in June is about to revolutionize the treatment of coronary artery disease, the No. 1 killer in the Western world. The study not only showed that a new device can potentially save many lives. It also offered a wonderful example of the benefit that can come from importing ideas from one area of medicine (immunology) into another (cardiology).
In the study, which appeared in The New England Journal of Medicine, 238 patients undergoing angioplasty for coronary artery blockages were randomly assigned to treatment with a standard stent or a drug-coated stent. Stents are tiny metallic coils that are inserted into an artery to keep it open. (Take out the spring from a ballpoint pen to see what one looks like.) During angioplasty, cardiologists first position a tiny catheter inside a blocked coronary and blow up a balloon to restore blood flow. Then they insert a stent to keep the artery from collapsing.
Stents have an Achilles' heel, however. They can injure an artery wall and trigger a kind of scar formation called ''in-stent restenosis.'' This scar tissue grows and eventually impedes blood flow. Approximately 30 percent of patients develop significant in-stent restenosis within one year.
So researchers had a clever idea. Why not coat a stent with something that prevents cells from dividing and proliferating? They decided on rapamycin, a powerful antibiotic that suppresses the immune system and stops cell division.
In The New England Journal study, metallic stents coated with rapamycin were used in 120 patients in Europe and Latin America. The researchers, led by a group in France, found that after one year nearly 27 percent of uncoated-stent patients needed another angioplasty. No one in the drug-coated group did.
Drug-coated stents, which could cost $3,000 each, may well change the practice of cardiology; some experts are even predicting the demise of coronary bypass surgery. Their predictions can be tested soon enough: F.D.A. approval of drug-coated stents is expected in April 2003. |
