A handful of coronary arteries in Pittsburgh soon will be equipped with a new dissolvable scaffold, one of the latest treatments for a leading cause of death in the U.S.
A new clinical trial announced Monday will allow researchers to test the effectiveness of a "bioresorbable vascular scaffold" in fighting coronary artery disease, which annually kills 385,000 Americans and costs $109 billion in treatment, according to Tony Farah, one of the principal investigators of the new treatment at Allegheny General Hospital.
"When someone had a heart attack in [the 1960s] -- the chances of death were 50 percent. We just put you in the hospital and prayed," said Dr. Farah, an interventional cardiologist and chief medical officer of the Allegheny Health Network.
"Right now that incidence of death has dropped down to about 5 or 6 percent."
Still, heart disease -- a broad term that includes coronary artery disease as its leading contributor -- is the top cause of death among men, women and every ethnic group in the U.S., according to the Cleveland Clinic.
About 500,000 people are treated for coronary artery disease each year with the installation of a metallic stent that helps expand arteries that are clogged with cholesterol or other cells -- commonly referred to as plaque.
Those metallic stents were a breakthrough in the mid-1990s, essentially replacing balloon angioplasty, and almost halved the number of patients whose arteries re-narrowed six months after treatment, experts said.
But because the metallic stents are permanent, they also can create health problems down the road.
The body often recognizes the metal as a foreign object and sends clotting agents, which can re-clog the artery and lead to a heart attack, according to Sameer Khandhar, an interventional cardiologist at UPMC Presbyterian.
The blood thinners used to combat clotting around the stent increase the risk of bleeding and can make other surgical procedures -- including coronary bypass -- nearly impossible.
The new dissolvable stent is designed partly to avoid the problems that come with a permanent metallic body residing in the coronary arteries.
"The idea is we will put it in, it will do its job, and then it will dissolve -- kind of like stitches," Dr. Khandhar said. "We think this will be the next era of how we treat coronary disease. This is the future of stents."
Even though clots form on traditional stents in less than 1 percent of cases, "because so many stents get put in each year, even rare complications end up affecting thousands of patients in the U.S.," according to general cardiologist Timothy Wong.
The dissolvable stent may work like modern stitches that don't need to be taken out, but they were much more difficult to design.
"The challenge is being able to come with a material that is strong enough to be able to hold that artery open, with its plaque and everything else for several months, and then gradually dissipate," Dr. Farah said. "The material that the stent is made of is essentially water and CO2. There is no concern of anything getting into the blood stream that is toxic."
The new technology is already out of the trial phase in Europe, parts of Latin America, Asia and India.
"So far, what we've seen outside the U.S. is that the stent is safe compared with other stents," Dr. Farah said, noting that it may cost more.
But regardless of the success of the trial, it will likely have ripple effects across the field.
"I have a ton of curiosity about what the outcome will be," Dr. Wong said. "It will impact the practice of cardiology one way or another."
Alex Zimmerman: firstname.lastname@example.org or 412-263-3909 or on Twitter @AGZimmerman.