Saturday, June 22, 2024

Now stents without polymers, no possibility post angioplasty problems!

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Dr. Ravi Kanth, Senior Interventional Cardiologist, Yashoda Hospital

Biodegradable/Permanent Polymer is used in 2nd Generation DES to carry the drug which would prevent restenosis but the disadvantage with this type of technology is that it causes delayed healing which can lead to stent thrombosis, sudden acute heart attacks, and heals prevent these polymer free Drug-eluting stents have been designed and we have such kind of technology.

These problems will not happen in new generation stents —
In India, 4.8 million people are diagnosed with cardiovascular disease every year. In these patients, about one million people undergo angioplasty due to coronary artery disease. In angioplasty, the patient’s heart blockage is opened without bypass surgery, but due to the stent being implanted in this procedure, the patient may have to face some problems later, such as swelling of the heart arteries, clotting or restenosis of the stent. These problems are likely due to the element (metal or polymer) the stent is made of. But now new generation stents are being made from different metals, which will not cause problems after angioplasty.

A new stent is made of cobalt chromium; it is plastic free–
The new generation stents are made of cobalt chromium metal instead of polymer. These are also drug-eluting stents that release 80 percent of the drug within 28 days of implantation and in these stents, a drug called “Probucol” has been used, which will act as a polymer but will not cause problems like that. Newer metal stents are more visible after implantation in imaging-guided angioplasty such as OCT or IVUS and are more flexible than earlier polymers. New generation stents are very beneficial for diabetic patients, who are prone to re-stenosis.

These problems occur in old generation stents—
Till now, only stents made of polymer (a type of metal or plastic), were used to implant the patient. Having a simple bare metal stent implant has a 15 to 30 percent risk of their re-blockage. In such a situation, the patient could have to face the problem of artery blockage again. At the same time, even after implanting a polymer-made drug-eluting stent, there is a 5% to 10 percent chance of it closing again because this plastic remains always in the patient’s artery, due to which swelling in the artery or plastic deposits in the artery is possible due to wear of the polymer. Problems such as stent re-stenosis, thrombogenicity, and stent thrombosis can surround the patient when it accumulates.

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