Tuesday, August 6, 2013

ABSORB, The New Bioresorbable Drug-Eluting Vascular Scaffold






Just came back from the hospital just now  after reviewing Encik K [ not Datuk Siti Norhaliza's Datuk K of course ]. Encik K , 58, recently retired Oil and Gas man from Petronas and Shell, currently doing some 'oil trading'  on his own told me his lifestyle is " nothing stressful doc" .

His crime? Sub-optimally controlled diabetese over 6 years and smoker, 20 sticks a day, 30 pack-years and carrying excess baggage of 30 kilogram. He weighs 100 kg , but only 170 cm in height. On top of these, he has hypertension over 10 years. All, 'push' factors for early coronary tree aging.

What is interesting in Encik K is that he is my first patient walking around from today with SDMC's first bioresorbable 'plastic-polymer' scaffold.

K presented to me last week just on a routine check up insisted by his wife. HBaic  blood result of 7.8 % told me that for the last 4 months or so his diabetic control was 'moderately sub-optimal'. A routine threadmill stress ECG nearly gave me a 'heart attack' !  He had a long spell of dysarrythmia, we called 'ventricular tachycardia', a precursor to a cardiac arrest, just shortly at the beginning of Bruce Stage 2 exercise protocol. I stopped his exercise test immediately and advice him to have a fairly  immediate coronary angiogram study to get a definitive road-map of his coronaries.

Today, just now at 5 pm, coronary angiogram showed critical 95 % stenosis [ 'narrowing' ] at the proximal Left Anterior Descending Artery near the Left Main Stem [ 'widow maker's junction', we cardiologists lovingly called it ].

After discussion with him [ on the table ], and his anxious wife, waiting outside the theatre, I opted to use the new resorbable 'plastic' stent instead of the now  aging ' 10 year-old  drug-eluting'metallic cage stents' [ stainless steel, cobalt chromium, or platinum coated ].

Vessel preparation and predilatation  and stent implantation technique are almost similar to the traditional metallic cage stenting. Cost-wise though,the new bioresorbalbe 'scaffold'  presently come with a hefty  40 %  increase in price com pared to the present work horse, the metalllic drug eluting stents, but 'insyaallah', with new players coming in, the cost will find its own level, hopefully much lower in future. Currently only Abbot Vascular Laborataries of America are the sole manufacturer of this  stent. It would not be long before others  join in the bandwagon. Siemen from Germany is already waiting in the wing to join the competition


From the cardiological perspective, this 'bioresorbable vascular scaffold' offers us more complete potential for 'restructuring and reconstruction' of diseased arterial tree.  The realities of Ischaemic heart disease it is both a  chronic and unrelenting disease. With the negative effect of affluence, sedentary lifestyle,  obesity, hypertension, and early diabetes,  we cardiologists are increasingly faced with  a new subset of younger and younger patients needing arterial construction. 

From my vantage point as a cardiologist, managing people with coronary artery disease is both an art and science of postponing the inevitable. It is my job to keep my patients from the inevitable ie that is surgery.  The downside to this  philosophy is that when it is time for 'my average patient' to have to undergone the 'final pathway', it is not uncommon now to see a patient in their  late  50's or 60's having  had 5 to 8 stents implanted, over the progress of time, all over the place in the coronary arterial tree. They present to our poor  cardiovascular surgical colleagues, a daunting task since their arterial tree are full of metallic cages.

It is hoped that with the bioresorbable stents increasing usage [ drug-eluting metallic stents still have a big role to play ], our surgeon can still do CABG on these individuals after postponing decades of  disease progression. But cardiac surgery at present is a 'sunset' profession as the cardiological tools and weapons attain more sophistication with the years. This is inevitable as coronary stenting is a multi billion dollars industry backed by engineering, bioengineering , genetics and allied sciences  all galvanized together by multinational devices companies of America and Europe.

At the end of the day,  we, the cardiologists have the best of  both  'soft as well as the hard' sciences', backing us, and a bludgeoning  devices companies competing to outdo each other to produce better and better 'devices'. For the poor cardiothoracic surgeons, they only have their 'bare hands'. 

This constitute 'unfair competition'. But what is unfair to the cardiothoracic surgeons can only be good  to all patients globally. Across the board in the field of medicine, the whole world is moving towards minimally invasive endoluminal techniques and away from having your chests, pelvis , brain or abdomen ripped open. If need be, it would have to be our last choice.


Nik Howk
1.30 am, Tuesday, Ramadan
Subang Jaya






ABSORB :
http://www.youtube.com/watch?v=ccLwmZ6Gwdc



1st Absorb Procedure in Dubai
http://www.youtube.com/watch?v=u91MOZSzhYs



They Are Getting Younger and Younger...
http://drnikisahak.blogspot.com/2013/07/they-are-getting-younger-and-younger.html



It Is Diabetes, Diabetes and Diabetes.........
http://www.youtube.com/watch?v=C30C5dthslc
[ editor's comment : if you are muslim, when he talk on deep breathing etc and etc, think about zikr..
this is a panacea of most ills ]










1 comment:

Mohsin said...

Dear Dr. Salam. Can you kindly advise regarding the costs associated with ABSORB for a 60 yr old female with severe TVD.