This article is about the Absorb Heart Stent, a new dissolving stent known as a Bio-absorbable Scaffold. Unlike traditional heart stents that remain for life, the Absorb heart stent dissolves over time to where it completely disappears. This has many advantages. In this article myheart.net author, and cardiologist Mustafa Ahmed MD of Princeton Baptist Medical Center, Birmingham, Alabama explains the Absorb stent. Dr Ahmed was amongst the first to implant the commercially available Absorb stent in the US. Dr Ahmed implanted the stent in a patient of cardiologist Dr. Alain Bouchard with a Widowmaker heart blockage at Princeton Baptist Medical Center, Birmingham, Alabama. In this article we present information on the new stent, then we show the story of Mr. Richardson, a patient with the Widowmaker blockage treated with this Absorb dissolvable stent. At the end of the article is a link to the patient story.
What is a Heart Stent?
Heart stents are used to treat blockages in the coronary arteries that supply the heart with blood. A total blockage in a coronary artery would lead to a heart attack, and if not treated rapidly can lead to death of heart muscle. A significant blockage of an artery, usually greater than 70%, can lead to symptoms such as chest pain, shortness of breath and heart muscle damage. Heart stents can be used to treat these heart blockages and open up the artery, relieving the blockage and restoring normal blood supply.
A heart stent is basically a small metal tube that is expanded inside the area of blockage. Once expanded it remains there and acts as a scaffold to keep the artery open. In the old days we used balloons to try and open the artery, but after the balloon was deflated the blockage would often recoil, meaning the chance of a successful procedure was not always good. With the development of heart stents, however, the scaffold from the stent prevented the recoil and meant the artery stayed open.
Problems with Traditional Heart Stents
Although the development of heart stents was a major breakthrough, the presence of these scaffolds within arteries was not entirely without problem. It’s important to remember that vessels are reactive in nature. They expand and constrict in response to various stimuli. This is prevented by metallic heart stents. Vessels themselves are always undergoing changes and the presence of heart stents can disrupt this process known as remodeling. If further work is required in other parts of vessels downstream to the heart stents, the heart stents can get in the way. Metallic heart stents often mean that patients are required to take life long blood thinning medication. These are just some of the problems associated with heart stents, and therefore it was very exciting when absorbable stents were developed.
Absorb Disappearing Stent
The absorb stent is known as a bio-absorbable vascular scaffold (BVS) and is a huge breakthrough. The development of the Absorb stent meant that the stent could do its job, but then disappear over time leaving the vessel still open.
For those wishing to dig a little deeper, the science underlying the Absorb heart stent is fascinating. It is made of a bio-absorbable polymer, which is broken down over time. It also releases a drug that prevents early vessel blockages from forming. The stent has three stages before it disappears. These are revascularization, restoration and reabsorption. Revascularization is when the stent is initially placed and restores blood flow in the vessel. In the restoration phase the stent begins to degrade and the vessel regains some of its natural properties. In the reabsorption phase, the Absorb heart stent completely disappears leaving a natural vessel behind.
Studies of the Absorb Heart Stent
The Absorb heart stent has been extensively studied with over 100,000 patients treated as part of trials or registries that have documented its usefulness and safety when used in the right patient population. Followup of up to 5 years has been demonstrated. Importantly, not only does the stent disappear, but also it is comparable in usefulness to existing stents.
Important to Place With Attention to Detail
Some studies showed that if not placed correctly there can be a possibility of stent blockage early on with the Absorb heart stent. It is therefore important to pay attention to detail when placing the stent. The artery needs to be prepared properly and the blockage dilated with the use of good-sized balloons. The artery needs to be of a decent size; the stent is not effective in vessels that are too small. After the stent is placed it should typically be dilated with a balloon that is appropriately sized to the vessel and the stent. Following the suggested protocols can minimize the risk of early stent problems. The Absorb heart stent can be visualized in the vessel using a technique known as optical coherence tomography.
Excellent article, thank you.
hello Sir,
i am From India day before yesterday my younger brother age 22 Having pain in chest when we went to see doctor they said 100% blockage in heart sir please help me what to do i am very tensed & so my whole family .!! he is very young please let guide us what to do .
Can you provide more stairs so i can help you to understand the situation better.
Respected sir,
I was diagnosed with blockage 90% on my OM-1 on vessels on angiogram while a routine cardiological check up @ 50 yrs of age when there was a positive TMT.Me a non diabetic.non smoker,mild hypertension around 130/90.Can I be managed medically?
I would have to see the films to comment accurately. Single vessel branch disease such as yours in many circumstances can be treated with medicine particularly if the medicine alleviates the symptoms. It also depends on the vessel size and the area felt to be at risk. Each case is different.
I don`t have any symptoms in chest,neither i felt any discomfort till stage three of TMT where i felt cramps,can`t upload video/picture of angio.me started with,aspirin,clopidogrel,metoprolol and atrovastatin.can I wait for symptoms to appear before they do angioplasty?
I don`t have any symptoms in chest
is it being used only in Princeton Baptist or available in medical centers all over States?
I just had my second CTA of chest. Have mild stenosis in several places but, have severe stenosis secondary to non-calcific and calcific plaque in my LAD mid. What is standard treatment protocol? No chest pain.
Not knowing the details of the case limits my perspective. However, most likely would recommend some form of stress testing next to determine the physiologic significance and the risk type of the lesion.
I had a one time chest pain and severe. My left arm sometimes hurts and tingles.
I now take two baby aspirins at night and the pain is gone. I now have pain under
my rib cage after I eat and I purp after eating. Does this have something to do with my heart and need I be concerned? I also have leg pain in my left leg it feels like pins and needles. My cholesterol is 170 and everything else is normal.
The symptoms appear to be atypical but a careful history and evaluation are still required then likely some form of stress testing. It may not at all be heart disease, but thats easier to say when there is evidence to rule it out.
My father is 71 year old he is diabetic and hypertension patient. Last time he stop his bp tablets and his bp shoot to 225 and then we make his angiography so the result is 3 vessels are block.
LAD has 70% lesion D1 has osteo proximal 70% and distal 80% D2 has proximal small vessel and ostial 70% lesion
L.cx this vessel has distal subtotal OM1 large vessel and ostial 40-50% lesion
RCA this vessel has ostial 70% lesion . Med 95% and distal total severe collateral from left system
Please advise
Its of course complex and not possible to answer a specific case without evaluating the patient fully. In most circumstances with this anatomy however surgery would be recommended.
Dear Dr
I have a total blockage of the right coronary artery very close to the heart. I’ve been told I’ve had it for a long time as it’s now being back filled via other means. My question is if this artery is for feeding the heart ,why is back filled doing anything as it still can’t enter the heart this way ?
You have what is known as a chronic total occlusion of the right coronary artery. I suspect the arteries on the left side of the heart have grown extra branches that are going over to the right and in some way have taken over the job of supplying that area. In many cases this is surprisingly effective and adequate. If there are symptoms or a positive stress test, there are techniques for stenting the blocked artery, however they are reserved for symptomatic or those with a significant abnormality on stress test or impaired heart function. In many cases however, only medical treatment is advised.
Given the large amount of people we have been able to help here at myheart.net, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at MustafaAhmedMD
I am a 37 year old female & I had a medicated stent put in to correct an 80% LAD blockage in 07/2014, due to insurance issues & trouble securing a good PCP let alone a cardiologist I had a massive heart attack one month ago (4/6/2017). Was explained to me that the cause was not having blood thinning medicines. This time it’s was again LAD however this time it was 100% blocked (apparently the old stent is what became blocked) again it was corrected with another yet different medicated stent. This time I ended up with a good cardiologist & together we are making sure that insurance doesn’t fail me again with my much needed medications. Anyway my question is: Is it possible the stent or the healing process or the damage that was done can be felt afterwards? My cardiologist said NO when I asked if I would/could be able to feel it. However since the heart attack I have a slight tinge of pain under my left breast. It comes & goes, it only lasts long enough to be noticed then it’s gone. It is not a major pain or even really a big discomfort but it’s definitely something, I am curious as to what you may think is either causing it or what could have caused it continue. Any ideas are much appreciated.
Thank you
Pain may be due to a number of factors but if the vessel is entirely open and there is no significant disease elsewhere then the artery blockage is not likely related and it is reassuring that your cardiologist isn’t worried and that the described pain is what we call atypical. If similar symptoms to the ones where you had the heart attack reccur then you must seek immediate attention.
Given the large amount of people we have been able to help here, we are starting a twitter to help keep heart patients up to date with advances and relevant information. Mine can be followed at @MustafaAhmedMD