Coronary artery disease (CAD) affects 15 million people in the United States and remains a leading cause of death worldwide despite decades of therapeutic advances. The Absorb device is a major advance in the treatment of CAD.
At Lourdes Health System, we are proud to offer this first-of-its-kind technology to patients. We are committed to providing patients with leading-edge treatments. Bioresorbable stents represent the future of treating heart disease.
Listen is as Dr. Vijay Verma describes the latest advances in stent procedures including the world’s first FDA-approved dissolving heart stent.
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The Latest Cardiac Technologies: New Dissolving Heart Stent
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Learn more about Vijay K. Verma, MD
Vijay K. Verma, MD
Vijay K. Verma, MD graduated from the University of California with a B.A. in Biology and Political Science. He received his M.D. degree from Saba University School of Medicine, Netherlands-Ant. He completed his internship and residency in internal medicine at the University of Connecticut School of Medicine, Farmington, CT. He completed his fellowships in cardiology and interventional cardiology at Cooper University Hospital - University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Camden, NJ.Learn more about Vijay K. Verma, MD
Transcription:
Melanie Cole (Host): Coronary artery disease affects 15 million people in the United States and remains the leading cause of death worldwide despite decades of therapeutic advances. The absorbable device is a major advancement in the treatment of coronary artery disease. My guest today is Dr. Vijay Verma. He's an interventional cardiologist with Lourdes Health System. Welcome to the show, Dr. Verma. Tell us what constitutes coronary artery disease.
Dr. Vijay Verma (Guest): Great. Thank you for having me. Coronary artery disease is a process that occurs within the heart arteries. These are the arteries that supply the heart muscle. These arteries, over time, can get blocked and the term that we use to describe it is atherosclerosis, or hardening of the arteries. The blockages of the heart arteries occur with cholesterol buildup and they may become calcified throughout the entire artery but there may be focal areas that become blocked, that are severe blockages, and can cause chest pain to occur.
Melanie: So, then, Dr. Verma, how has it been typically treated if somebody is diagnosed with atherosclerosis and you see they have blockages in their arteries? This puts them at a high risk for a heart attack, yes?
Dr. Verma: So, yes, blockages in the arteries cause heart attacks but, more commonly, they do cause angina, or chest pain, from the heart, so there are two different processes that go on. Over time, people may have lots of blockages but if the blockages are severe, usually about 70% or more narrowed in the heart arteries, that limits the amount of blood flow, especially at exercise. So, those patients tend to have chest pain from these blockages and that, we term as “angina”. The heart attack may occur from blockages that are severe or even moderate and what happens in a heart attack is the tip of the blockage ruptures and there's a cut inside the artery and it sends all of its’ clotting mechanism there to block off that area and that creates a sudden, complete blockage of the artery and that complete blockage causes a heart attack. They do stem from the same type of blockages in terms of this cholesterol plaque buildups, but the processes are somewhat different in terms of the angina as well, compared to the heart attack.
Melanie: Based on the severity of the blockage, how is this typically been treated?
Dr. Verma: Typically, it's been treated with medications, initially. If you have angina, we try to treat with medications. It’s more of a conservative strategy. If the medications don't work, then we do treat with - in the past it was balloon angioplasty, and that was in the late ‘70s or early ‘80s when balloon angioplasty came out, and stents were invented around 1994 and they became commercially available. So, that was the mainstay therapy until about 2003. In 2003, the metal stents had drug coating on them to reduce the risk of re-blockage, we call those drug-eluting stents. Those stents have been the mainstay of therapy for coronary intervention over the last several years until now that the bioresorbable vascular scaffold was developed, the BVS as we call it. It's similar to a stent in that it's a scaffolding but it is a way to treat the artery without leaving something behind, long-term.
Melanie: So, typically the metal stents you've been using stay in the patient for the rest of their lives?
Dr. Verma: Correct. Once a stent is embedded in the artery, it cannot come out.
Melanie: So then, tell us about this new vascular scaffold, or the bioresorbable stent.
Dr. Verma: It's an exciting new technology that has been developed by Abbott Labs for the last several years and now we were part of clinical trials at our hospital. I was the principal investigator as well as multiple other sites throughout the country as well as the world. It's a novel approach for treating heart disease, treating these blockages with a stent-like structure. We call it a “vascular scaffold”. It does what a stent does initially, but over time, it can resorb within the walls of the blood vessel when you don't need a scaffold. You really only need a scaffold for the first 6 to 12 months. After that, the tissue around the blockage can remodel and you no longer need something to keep the artery propped open.
Melanie: That's a great definition of it; very explanatory . Now, if this bioresorbable stent then does absorb into the system, can that area close back up again? What happens?
Dr. Verma: There's always a risk of re-narrowing that can occur with heart disease. Blockages can occur even with a stent that's there. The normal stents that we've been putting in with the drug coating help reduce the risk of re-blockage, specifically over that first six to 12 months and then up to one to two years, when there's a large amount of inflammation that creates the renarrowing. Usually the renarrowing that occurs in the stent is not a cholesterol plaque buildup, it's actually smooth muscle cells; it's actually tissue growth within that stent, because of the inflammation that is created by putting a metal stent in. That's why the stents were coated with this medication--to help reduce the risk of renarrowing. That same medication is now also put on the bioresorbable scaffold in order to help reduce that risk of renarrowing within the first six to 12 months when that inflammation is at its peak.
Melanie: And you mentioned that the musculature, as it were, of the artery then becomes strong enough to maintain its own width, its own size. So, how does that occur?
Dr. Verma: With the bioresorbable scaffold, over time it starts breaking down. And it breaks down into carbon dioxide and water, which are naturally occurring substances within your body. The muscles in that area become used to that structure and so no longer are they exerting pressure to try and close the artery. We call that “negative remodeling”. That happens initially when a vessel is propped open. Over time, the bioresorbable scaffold is made out of a substance similar to the absorbable sutures that people get and that is uptaken into the body. The good thing is that--and it has the potential to restore the natural function that makes it unique in the treatment of heart disease because, for example, when you exercise, your arteries normally dilate. It's hard for your arteries to dilate if there's a metal stent in there and, theoretically, the vessel will then move, flex, pulsate, similar to a natural vessel rather than a vessel that has a metal scaffolding sitting in it.
Melanie: That's fascinating. Dr. Verma, what do you tell patients about living with that bioresorbable stent and what would you like them to know about lifestyle modifications after that stent's been placed?
Dr. Verma: Great. The first thing I always tell patients whenever I place any type of stent in is that this is not a cure for your disease. There is no cure for heart disease. Heart disease is treated. It's treated in a multi-pronged, multi-faceted approach. It's treated with lifestyle changes, exercise, eating correctly. It's treated with medications that you have to take, even if you have a stent, a drug-coated stent or a bioresorbable stent, all of these stents require you to be on certain types of anti-platelet or blood thinner medication for short or long-term. Then, they have to take other medications because the disease process is still continual throughout the body, throughout the heart and that's why it's required to lower their cholesterol to as low as possible, blood pressure, reducing other major risk factors such as smoking and obesity. Those are all important things in terms of treating heart disease. In terms of the bioresorbable vascular scaffold, it's not for everybody just yet. Right now, it's being studied in vessels, at least compared to the various sizes of artery that can be in the heart, for moderate or larger arteries. For very small arteries, it's very difficult to place the scaffolding, especially if it's a segment of the artery that's very tortuous, lots of twists and turns to get down to. The delivery device is still bulky because it's a first-generation device. So, it is a little bit harder to get down in certain anatomy. So, therefore, it's not for every patient, every blockage. We make that decision when we do the catheterization. We see where the blockage is and if it needs to be fixed, what is the best way to fix it. If we can fix it, we use a bioresorbable stent, we tend to use that; if not, we use the traditional drug-coated stent.
Melanie: Dr. Verma, in just the last few minutes, please give our best advice for coronary artery disease and why patients should come to Lourdes Health System for their care.
Dr. Verma: Our Lady of Lourdes is unique. It's a hospital that has a very large number of cardiologists. It provides cardiac services that are unparalleled within the Philadelphia region. Because it's been traditionally a very cardiac-centric hospital, the services, the devices, the doctors, the nurses, the staff are very used to the entire spectrum of heart disease patients. So, for a patient looking at a hospital, looking at a health system, to come to for their heart disease. It almost is a no-brainer to come to Our Lady of Lourdes if you live in this area.
Melanie: Thank you so much for being with us today. It's great information. You're listening to Lourdes Health Talk. For more information, you can go to www.lourdesnet.org. That's www.lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): Coronary artery disease affects 15 million people in the United States and remains the leading cause of death worldwide despite decades of therapeutic advances. The absorbable device is a major advancement in the treatment of coronary artery disease. My guest today is Dr. Vijay Verma. He's an interventional cardiologist with Lourdes Health System. Welcome to the show, Dr. Verma. Tell us what constitutes coronary artery disease.
Dr. Vijay Verma (Guest): Great. Thank you for having me. Coronary artery disease is a process that occurs within the heart arteries. These are the arteries that supply the heart muscle. These arteries, over time, can get blocked and the term that we use to describe it is atherosclerosis, or hardening of the arteries. The blockages of the heart arteries occur with cholesterol buildup and they may become calcified throughout the entire artery but there may be focal areas that become blocked, that are severe blockages, and can cause chest pain to occur.
Melanie: So, then, Dr. Verma, how has it been typically treated if somebody is diagnosed with atherosclerosis and you see they have blockages in their arteries? This puts them at a high risk for a heart attack, yes?
Dr. Verma: So, yes, blockages in the arteries cause heart attacks but, more commonly, they do cause angina, or chest pain, from the heart, so there are two different processes that go on. Over time, people may have lots of blockages but if the blockages are severe, usually about 70% or more narrowed in the heart arteries, that limits the amount of blood flow, especially at exercise. So, those patients tend to have chest pain from these blockages and that, we term as “angina”. The heart attack may occur from blockages that are severe or even moderate and what happens in a heart attack is the tip of the blockage ruptures and there's a cut inside the artery and it sends all of its’ clotting mechanism there to block off that area and that creates a sudden, complete blockage of the artery and that complete blockage causes a heart attack. They do stem from the same type of blockages in terms of this cholesterol plaque buildups, but the processes are somewhat different in terms of the angina as well, compared to the heart attack.
Melanie: Based on the severity of the blockage, how is this typically been treated?
Dr. Verma: Typically, it's been treated with medications, initially. If you have angina, we try to treat with medications. It’s more of a conservative strategy. If the medications don't work, then we do treat with - in the past it was balloon angioplasty, and that was in the late ‘70s or early ‘80s when balloon angioplasty came out, and stents were invented around 1994 and they became commercially available. So, that was the mainstay therapy until about 2003. In 2003, the metal stents had drug coating on them to reduce the risk of re-blockage, we call those drug-eluting stents. Those stents have been the mainstay of therapy for coronary intervention over the last several years until now that the bioresorbable vascular scaffold was developed, the BVS as we call it. It's similar to a stent in that it's a scaffolding but it is a way to treat the artery without leaving something behind, long-term.
Melanie: So, typically the metal stents you've been using stay in the patient for the rest of their lives?
Dr. Verma: Correct. Once a stent is embedded in the artery, it cannot come out.
Melanie: So then, tell us about this new vascular scaffold, or the bioresorbable stent.
Dr. Verma: It's an exciting new technology that has been developed by Abbott Labs for the last several years and now we were part of clinical trials at our hospital. I was the principal investigator as well as multiple other sites throughout the country as well as the world. It's a novel approach for treating heart disease, treating these blockages with a stent-like structure. We call it a “vascular scaffold”. It does what a stent does initially, but over time, it can resorb within the walls of the blood vessel when you don't need a scaffold. You really only need a scaffold for the first 6 to 12 months. After that, the tissue around the blockage can remodel and you no longer need something to keep the artery propped open.
Melanie: That's a great definition of it; very explanatory . Now, if this bioresorbable stent then does absorb into the system, can that area close back up again? What happens?
Dr. Verma: There's always a risk of re-narrowing that can occur with heart disease. Blockages can occur even with a stent that's there. The normal stents that we've been putting in with the drug coating help reduce the risk of re-blockage, specifically over that first six to 12 months and then up to one to two years, when there's a large amount of inflammation that creates the renarrowing. Usually the renarrowing that occurs in the stent is not a cholesterol plaque buildup, it's actually smooth muscle cells; it's actually tissue growth within that stent, because of the inflammation that is created by putting a metal stent in. That's why the stents were coated with this medication--to help reduce the risk of renarrowing. That same medication is now also put on the bioresorbable scaffold in order to help reduce that risk of renarrowing within the first six to 12 months when that inflammation is at its peak.
Melanie: And you mentioned that the musculature, as it were, of the artery then becomes strong enough to maintain its own width, its own size. So, how does that occur?
Dr. Verma: With the bioresorbable scaffold, over time it starts breaking down. And it breaks down into carbon dioxide and water, which are naturally occurring substances within your body. The muscles in that area become used to that structure and so no longer are they exerting pressure to try and close the artery. We call that “negative remodeling”. That happens initially when a vessel is propped open. Over time, the bioresorbable scaffold is made out of a substance similar to the absorbable sutures that people get and that is uptaken into the body. The good thing is that--and it has the potential to restore the natural function that makes it unique in the treatment of heart disease because, for example, when you exercise, your arteries normally dilate. It's hard for your arteries to dilate if there's a metal stent in there and, theoretically, the vessel will then move, flex, pulsate, similar to a natural vessel rather than a vessel that has a metal scaffolding sitting in it.
Melanie: That's fascinating. Dr. Verma, what do you tell patients about living with that bioresorbable stent and what would you like them to know about lifestyle modifications after that stent's been placed?
Dr. Verma: Great. The first thing I always tell patients whenever I place any type of stent in is that this is not a cure for your disease. There is no cure for heart disease. Heart disease is treated. It's treated in a multi-pronged, multi-faceted approach. It's treated with lifestyle changes, exercise, eating correctly. It's treated with medications that you have to take, even if you have a stent, a drug-coated stent or a bioresorbable stent, all of these stents require you to be on certain types of anti-platelet or blood thinner medication for short or long-term. Then, they have to take other medications because the disease process is still continual throughout the body, throughout the heart and that's why it's required to lower their cholesterol to as low as possible, blood pressure, reducing other major risk factors such as smoking and obesity. Those are all important things in terms of treating heart disease. In terms of the bioresorbable vascular scaffold, it's not for everybody just yet. Right now, it's being studied in vessels, at least compared to the various sizes of artery that can be in the heart, for moderate or larger arteries. For very small arteries, it's very difficult to place the scaffolding, especially if it's a segment of the artery that's very tortuous, lots of twists and turns to get down to. The delivery device is still bulky because it's a first-generation device. So, it is a little bit harder to get down in certain anatomy. So, therefore, it's not for every patient, every blockage. We make that decision when we do the catheterization. We see where the blockage is and if it needs to be fixed, what is the best way to fix it. If we can fix it, we use a bioresorbable stent, we tend to use that; if not, we use the traditional drug-coated stent.
Melanie: Dr. Verma, in just the last few minutes, please give our best advice for coronary artery disease and why patients should come to Lourdes Health System for their care.
Dr. Verma: Our Lady of Lourdes is unique. It's a hospital that has a very large number of cardiologists. It provides cardiac services that are unparalleled within the Philadelphia region. Because it's been traditionally a very cardiac-centric hospital, the services, the devices, the doctors, the nurses, the staff are very used to the entire spectrum of heart disease patients. So, for a patient looking at a hospital, looking at a health system, to come to for their heart disease. It almost is a no-brainer to come to Our Lady of Lourdes if you live in this area.
Melanie: Thank you so much for being with us today. It's great information. You're listening to Lourdes Health Talk. For more information, you can go to www.lourdesnet.org. That's www.lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
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