Tiny gadget can prevent heart surgery

by MARTYN HALLE, Daily Mail

Scientists have developed a new method to prevent thousands of people having to undergo major heart surgery for blocked arteries.

It is an advance on a technique called 'stenting', itself hailed as a revolutionary treatment for cardiac patients when it was introduced more than ten years ago.

It involves feeding metal mesh tubes into the arteries leading to the heart, to prevent them from closing due to disease. For many patients, it has saved them having to undergo cardiac bypass surgery.

A stent is fed into a narrowed artery through an incision in the groin, under local anaesthetic. Up to three or four stents are placed in one or several arteries. They hold open an artery that would close due to disease.

But while the use of stents has been highly successful, there has also been a high failure rate. As many as 30 per cent of stents fail within six months.

What sometimes happens is that new tissue starts to grow through the walls of the stent and the artery begins narrowing again.

'It's a sort of inflammatory reaction caused by the immune system wanting to heal the area around the stent,' says London cardiologist Charles Knight.

The majority of these patients who've had this growth then go on to have open heart surgery to bypass the blocked arteries. It's a major operation which is not without risk and best avoided.

But now cardiologists believe they have found a way of preventing stent patients ending up in the operating theatre. They have developed a coated stent which counteracts the re-narrowing that takes place in the arteries of some patients.

The new stents, called Cypher, are coated with an antibiotic drug called Rapamune. This helps damp down the immune system reaction to the stent, allowing normal healing to take place. 'To date none of the stents has failed, leading to a patient needing open heart surgery,' says Dr Knight.

'So we have 100 per cent effectiveness, for the moment. There are on-going trials. It is too early to say that it will never fail. '

One of the first patients to benefit from having a new-style stent is 33-year-old Sarah Turnball, who has suffered high blood pressure and thickening blood after a kidney transplant 11 years ago. As a result, she has had two heart attacks since the age of 31.

After her first heart attack, in November 2000, cardiologists at Southampton University Hospital fitted her with a conventional stent to widen a narrowing artery.

When she suffered her second heart attack last August, her consultant, Ian Simpson, investigated and discovered that the stent was failing and the artery was beginning to narrow again.

For Sarah, major heart surgery would have been extremely risky. 'I only have one kidney and that was a result of a transplant because I had my own kidneys removed 11 years ago,' she says.

'But because my kidney match was not the best, it has caused a thickening of my blood and raised my blood pressure. I have also suffered several deep vein thromboses and a pulmonary embolism, and the doctors thought it too risky to have the heart surgery.'

Sarah, from Maiden Newton, near Dorchester, Dorset, is hoping the new stent in her artery will prevent her suffering future heart attacks.

'I've been through an awful lot in my life, but having those heart attacks was pretty frightening. I thought I was going to die,' she says.

It is too early to tell whether the new stent will do the trick for Sarah in the long term, but Dr Simpson is optimistic.

Sarah is also confident all is well and is about to embark on her travels shortly, heading for Egypt, Thailand, Australia and New Zealand. 'I'm hoping the stent will give me a whole new lease of life.'

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