On Thursday, medical correspondent Dr. Emily Senay details a breakthrough that is helping perfect the art of reopening clogged arteries.
Angioplasty is used to unclog blocked arteries, but Senay says it's not always that easy.
Each year in this country more than half a million people have an angioplasty to reopen clogged arteries. For most, it is an effective and permanent fix.
The procedure involves threading a balloon catheter into the artery, inflating the balloon to unblock the artery, and then installing a stent - a wire mesh tube - to hold the artery open. But sometimes scar tissue forms around the stent to cause another blockage.
"An average of about 20 percent of the stents blocked up and in certain particular patients, the blockages [were]as many as 30 or 40 percent reblock," explains Dr. Jeffrey Moses, chief of interventional cardiology at Lenox Hill Heart And Cardiovascular Institute in New York, where doctors use a new stent, coated with a drug that prevents scarring, for 95 percent of patients.
"These stents with the drugs on it cut that reblockage down dramatically, and in certain cases eliminate it entirely," says Dr. Moses.
For heart patient Fred Schwarz, ordinary stents were not working.
"I'd get on the treadmill and I couldn't go very far and I started getting chest pains," says Schwarz.
These days, he is getting drug-coated stents to replace the old ones; so far so good.
He hopes one more procedure will keep him out of the hospital for a while. "I would think that this will now clear up the last place that's causing problems and I can go on for several years without dealing with this," he says.
Moses says, "By any criteria, this is what we call a breakthrough technology. This solves a problem that has been plaguing angioplasty for 25 years."
The new generation of stents are expected to change the landscape of heart disease. It will decrease the number of people who go on to need bypass surgery.
"There's no question about it," says Dr. Moses. "For two reasons: number one, certain people who get reblockages and reblockages with the stents go on to bypass - that would be a thing of the past. Also, there are many patients we send to bypass now because we are afraid the reblockage rate is so high it doesn't pay to do the stenting. But those patients now will get the stents. I would use what we call the mother test, 'How would I treat my mother?' And assuming you like your mother, which I do, I would want that to be the first-line therapy," he says.
Most people are candidates for angioplasty, but there are certain patients with a history of disease who are not.
The FDA is expected to approve these new drug-coated stents sometime this year. And it's expected they'll quickly become the preferred treatment; as many as 70 percent of all stents will be drug-coated.
Angioplasty is not widely available. It depends on where you are located. Angioplasty centers require highly skilled doctors in specialized places that require a lot of money and resources, and not every place has that available. So clot busters are used in areas where they don't have angioplasty.