Nav: Home

RUDN medics suggested modifications to coronary artery stenting

November 20, 2018

Bifurcation lesions are a challenge even for an experienced cardiac surgeon. Currently, there are two surgical techniques for dealing with them but no consensus of the medical community on which one applies to which case. Russian scientists suggested and successfully tested on 128 patients a new surgical technique involving stents and drug-eluting balloon catheters. "We decided to study a new method using a drug-eluting balloon catheter with a cytostatic agent that prevents cellular growth and may improve the results of the treatment. It is the first time this method is used in patients with true left main bifurcation lesions," said a co-author of the study Daniil Maximkin, candidate of medical sciences, and assistant professor of the department of hospital surgery with a course of pediatric surgery and the department of cardiovascular surgery at the Faculty of Additional Training for Medical Personnel, Institute of Medicine, RUDN.

Coronary artery disease is one of the most common heart conditions associated with blood supply of the heart. The heart is supplied by special blood vessels called coronary arteries. They bifurcate asymmetrically, causing complex vortex currents to form in the blood flow. These turbulent currents put additional friction on internal blood vessel walls, irritating them mechanically. This is why the internal walls of coronary arteries are prone to inflammations which may lead to the formation of atherosclerotic plaques. Plaques cause luminal occlusion, and as a result a patient suffers from ischemia.

RUDN surgeons pointed out that 20-30% of patients with CAD have damage at bifurcation points of coronary arteries. "Despite the growing number of surgical techniques addressing this type of damage, none of them is perfect," explains Daniil Maximkin. "To a great extent, everything depends on the anatomy of bifurcation itself. The angle between the vessel and its ramus, the presence of calcinosis (deposits of calcium salts), and the duration of the condition all play important roles. Therefore, each case requires an individual approach."

For the vessel not to constrict too much, cardiac surgeons use a stent - a thin and flexible wire tube that unfolds in a vessel and expands its diameter. A stent is delivered to an artery in a folded-up form via a catheter tube in a patient's hip or arm. After that surgeons unfold the stent using a special balloon that expands the stent until it reaches the required diameter. Then the balloon is removed, and the stent remains in the blood vessel. If arterial plaques clog the lumina of the left coronary artery, the surgeons can stent only the left main (in this case the stent is unfolded using two balloons by means of the so-called "kissing balloons" technique) or put in two stents - into the main and its ramus. Both options have disadvantages: double stenting is associated with high risk of complications (including heart attack) in the long term, and in the case of one stent method the plaque may grow back.

Following the new procedure, RUDN cardiac surgeons used only one stent for the left main coronary artery, and a balloon without a stent was unfolded in the ramus to protect it from recurring formation of plaques. The balloon released a cytostatic agent (a medicinal drug preventing cell growth) to block inflammatory processes and plaque growth. This technique was compared with the single-stent method in clinical trials, and the patients that underwent the new surgical procedure showed lower rates of repeated luminal occlusion.

"The results after the use of a drug-eluting balloon catheter were much better than after the single-stent method with regular balloon catheters. Namely, there were less complications in the long term, and the state of the lumina was better. This is virtually an alternative to the double-stent technique," summarized Daniil Maximkin. The scientists plan to monitor long-term consequences of surgeries and collect data to understand whether this method can be implemented into common surgical practice.
-end-


RUDN University

Related Blood Vessel Articles:

Nanoengineers 3-D print biomimetic blood vessel networks
Nanoengineers at the University of California San Diego have 3-D printed a lifelike, functional blood vessel network that could pave the way toward artificial organs and regenerative therapies.
See how immune cells break through blood vessel walls
Despite the constant assault of immune cells poking holes in your blood vessels, the damage is negligible, and in a study, appearing Jan.
Studying blood flow dynamics to identify the heart of vessel failure
New research from a fluid mechanics team in Greece reveals how blood flow dynamics within blood vessels may influence where plaques develop or rupture this week in Physics of Fluids.
'Fixing' blood vessel cells to diagnose blood clotting disorders
A new device developed at the Wyss Institute for Biologically Inspired Engineering could monitor blood clot formation and diagnose effectiveness of anti-platelet therapy by microengineering tiny hollow channels lined by chemically 'fixed' human endothelial cells that more closely mimic cellular and vascular flow conditions inside a patient's body than a bare surface.
Bioengineered blood vessel is safe for dialysis patients, study finds
A Yale scientist collaborated with researchers at Duke University and surgeons in Poland and the United States to create bioengineered blood vessels for kidney-disease patients on dialysis.
Heartburn drug damages blood vessel cells in lab finding
A commonly used heartburn medication caused blood vessel cells to age faster in laboratory testing.
New insights in blood vessel formation
How vascular tubes build, maintain and adapt continuously perfused lumens to meet local metabolic needs remains poorly understood.
Cancer drug could treat blood vessel deformities
A drug currently being trialled in cancer patients could also be used to treat an often incurable condition that can cause painful blood vessel overgrowths inside the skin, finds new research in mice led by UCL, Memorial Sloan Kettering Cancer Center in New York and the Bellvitge Biomedical Research Institute in Barcelona.
PTSD may affect blood vessel health in veterans
Post-traumatic stress disorder may decrease the ability of blood vessels to dilate, raising the risk of heart attack and stroke in Veterans.
Some medications increase risk of blood vessel constriction in extremities
A recent review of the medical literature has identified 12 classes of drugs and four main pathophysiological mechanisms that can cause a side effect whereby small arteries that supply blood to the skin constrict in response to cold, limiting blood supply.

Related Blood Vessel Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Bias And Perception
How does bias distort our thinking, our listening, our beliefs... and even our search results? How can we fight it? This hour, TED speakers explore ideas about the unconscious biases that shape us. Guests include writer and broadcaster Yassmin Abdel-Magied, climatologist J. Marshall Shepherd, journalist Andreas Ekström, and experimental psychologist Tony Salvador.
Now Playing: Science for the People

#513 Dinosaur Tails
This week: dinosaurs! We're discussing dinosaur tails, bipedalism, paleontology public outreach, dinosaur MOOCs, and other neat dinosaur related things with Dr. Scott Persons from the University of Alberta, who is also the author of the book "Dinosaurs of the Alberta Badlands".