New option for treatment of Coronary Artery Disease

 Symptoms include chest pain and shortness of breath, especially during exercise.

Care is traditionally provided through lifestyle changes, drugs and in more severe cases through angioplasty, a surgical intervention and the placement of a balloon and stent. 

Today, however, coronary artery disease can also be treated with a minimally invasive procedure using a bioresorbable vascular scaffold. 

This new innovation performs similarly to a stent but without leaving an implant and involves the insertion of a non-metallic mesh tube that dissolves naturally after 2 years once the artery has the ability and strength to stay open on its own. This is similar to the way a cast supports a broken arm and is then removed. The bioresorbable vascular scaffold is made from polylactide, a material commonly used in other medical devices such as dissolving stitches. It breaks down into substances already found in the body: water (H2O) and carbon dioxide (CO2).

Since no metal stent is left behind, it allows the blood to flow normally and the vessel to expand or contract as needed. The bioresorbable vascular scaffold eliminate concerns about receiving a permanent implant, allows for a quick return to everyday activities, helps to reduce chance of future coronary artery disease symptoms and is thought to positively impact long-term heart health.

The patient will be instructed not to drink or eat before the procedure and may be given aspirin or other medications with a little water so as to prevent blood clots during the procedure. 

The procedure will be performed in a special room called a catheterisation lab. The patient can remain awake and ask questions or respond to the doctor. For his part, the doctor will gain access to the coronary arteries through the groin, wrist or arm. The area will be cleaned and shaved, and the patient given local anaesthesia to numb the area. Patients are encouraged to remain relaxed and calm during the procedure, which usually takes about 1 hour.

The scaffold is first placed into the artery on a balloon at the end of a long, thin, flexible tube called a catheter then expanded by inflating the balloon to push the plaque against the artery wall and enable greater blood flow. The balloon is then deflated and removed, leaving the scaffold to slowly release medication to the affected area. Over time, the scaffold dissolves completely, enabling the artery to return to a natural state once more.

It is normal to feel some chest pain or mid pain when the balloon is expanded during the procedure and the patient should feel free to tell the doctor or nurse if he experiences any discomfort. However, this is normal and should quickly fade when the balloon is removed.

Most patients stay overnight at the hospital and return home the next day. On discharge, they will be given instructions as to the medications they need to take as part of their recovery and follow-up treatment. They should also stick to the recovery period prescribed by the doctor before resuming normal activities and returning to work. Immediate medical attention must be sought if any abnormalities are experienced.

As ever, prevention is always better than cure. To avoid heart disease:

> Have periodic check-ups with your doctor so that your condition can be closely monitored.

> Monitor your weight. In case of excess weight, losing even 2.5 – 5 kg can reduce the risk of coronary artery disease.

> Eat a healthy diet, such as fruits, vegetables and low-fat meats.

> Engage in regular physical activity. Consult a doctor for proper exercise advice.

> Quit smoking. There are several organisations that can provide useful advice on quitting.

> Seek the support of your family and friends, such as engaging together in recreational activities, exercising and eating healthy food.

 

 

Dr Mann Chandavimol is a cardiologist at

Samitivej Sukhumvit Hospital’s Heart Centre. Call (02) 711 8110-2