Bare-Metal Stents Are Better For Some Heart Patients
While drug-eluting stents are effective in keeping open diseased heart arteries, they should not be used for patients who need to have non-cardiac surgery a short time after an interventional heart procedure.
A presentation at the Society for Cardiovascular Angiography and Interventions in Orlando by cardiologists at Jefferson Medical College indicates that for these patients, bare metal stents provide a safer choice.
"The issue here," says Michael Savage, M.D., Catheterization Laboratory Director at Thomas Jefferson University Hospital in Philadelphia, "is that studies have demonstrated that those patients who receive drug-eluting stents may develop life-threatening cardiac complications if they undergo subsequent, non-cardiac surgery."
This prescription for the potentially deadly problem begins when a person, often a senior citizen, learns that she or he must have elective surgery. The surgery can be for a minor to a major problem--from vacular surgery to fix blood flow problems, to broken hips or bones, neurological or urological issues and more.
Often, severe coronary artery disease is discovered during the pre-surgical testing. If severe, it presents a more-immediate problem and therefore, must be treated before the patient undergoes the elective surgery.
Prior studies have shown that patients may suffer fatal heart attacks due to clotting inside of the stents when surgery is performed within a few weeks after stent placement. In the case of drug-eluting stents, clotting of the stent may occur even months or years after their heart procedure, particularly when their blood thinning medicine (usually aspirin and Plavix) are stopped before the surgery.
To avoid the potentially deadly scenario, the Jefferson Medical College researchers developed a clinical protocol to enable patients to have both procedures successfully with little risk. Led by Agostino Ingraldi, M.D., a fellow in cardiovascular diseases, they developed the following four-part strategy: