Stents may reduce heart attacks by delivering downstream medication

Tuesday, September 13, 2011, Cleveland: Researchers at Cleveland Clinic have discovered that cardiac patients receiving medicated stents – a procedure that occurs often when blood vessels are blocked – have a lower likelihood of suffering heart attacks or developing new blockages in the vessel downstream from the stent.

Stents have been used to prevent re-narrowing of coronary arteries after balloon angioplasty and newer designs have included coatings with medications to prevent re-narrowing from occurring within the stent after implantation. The recent study – led by Richard Krasuski, M.D., Director of Adult Congenital Heart Disease Services and a staff cardiologist in the Section of Clinical Cardiology in the Department of Cardiovascular Medicine at the Miller Family Heart & Vascular Institute at Cleveland Clinic ¬– suggests that these medicated stents may deliver the medication to the vessel beyond the stent.

In a study recently published in the American Heart Journal, Dr. Krasuski and his colleagues demonstrate that patients receiving medicated stents have a lower likelihood of suffering heart attacks or developing new blockages in the vessel downstream from the stent.

"Though there have been concerns about clots forming inside drug-releasing stents, the totality of data suggests that patients receiving drug-coated stents do better than patients receiving bare metal stents," Dr. Krasuski said. "It has not been clear before, however, why preventing re-blockage in the location of a stent would have such a large benefit, but our study suggests that there may be more that the stent is doing. When blood flows through the stent, medication not only reaches the vessel it is touching but likely the distal vessel as well. In this way it could be having a much more profound effect on the vessel."

If this concept is confirmed it could revolutionize treatment of cardiovascular disease and problems with other organ systems as well. Stents could be altered to deliver many different medications in small amounts directly to the blood vessels. This could maximize the benefits of different drugs and reduce their toxic effects as well as improve patient compliance.

Celebrating its 90th anniversary, Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. It was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation's best hospitals in its annual "America's Best Hospitals" survey. About 2,800 full-time salaried physicians and researchers and 11,000 nurses represent 120 medical specialties and subspecialties. Cleveland Clinic Health System includes a main campus near downtown Cleveland, nine community hospitals and 15 Family Health Centers in Northeast Ohio, Cleveland Clinic Florida, the Lou Ruvo Center for Brain Health in Las Vegas, Cleveland Clinic Canada, and opening in 2013, Cleveland Clinic Abu Dhabi. In 2010, there were 4 million visits throughout the Cleveland Clinic health system and 155,000 hospital admissions. Patients came for treatment from every state and from more than 100 countries. Visit us at www.clevelandclinic.org. Follow us at www.twitter.com/ClevelandClinic.