Bioresorbable Scaffolds (BRS) are often referred to as dissolving stents due to their temporary nature.
Dr Anuj Bhasin
Rising Heart Disease in Young Adults in India
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The prevalence of Coronary Artery Disease (CAD) is escalating rapidly among younger populations in India, posing a significant public health challenge. While previously considered a disease of older adults, CAD is now being diagnosed in people in their 30s, 40s, and 50s. Lifestyle changes, including poor diet, lack of exercise, increased stress, and genetic predispositions, are fueling this alarming trend. This shift underscores the urgent need for heightened awareness and early preventive measures to reduce the burden of heart disease in the country.
CAD Treatment & Metal-Less Angioplasty:
The treatment landscape for CAD has evolved significantly. In the past, angioplasty where a metallic drug-eluting stents (DES) were used to widen the blocked arteries was the standard approach. In recent years, metal-less angioplasty has emerged as a ground-breaking alternative to traditional stenting. Unlike metal stents that remain in the artery permanently, this innovative approach focuses on opening the artery without leaving any permanent materials behind. It allows the arteries to heal naturally; aligning with the body’s healing processes.
Innovative Approaches: Bioresorbable Scaffolds (BRS) & Drug-Coated Balloons (DCB)
As advancements in coronary artery disease (CAD) treatment continue, Bioresorbable Scaffolds (BRS) and Drug-Coated Balloons (DCB) represent cutting-edge technologies that aim to treat artery blockages while reducing the need for permanent implants, offering new hope for young patients in particular.
Bioresorbable Scaffolds (BRS): A Step Towards Natural Healing
Bioresorbable Scaffolds (BRS) are often referred to as dissolving stents due to their temporary nature. They are designed to provide the immediate structural support needed to keep arteries open after angioplasty and dissolve over time.
Key Features and Benefits of BRS:
Temporary Support: Just like traditional metal stents, BRS are inserted into the blocked artery to physically open it and restore normal blood flow. However, unlike metal stents, which remain permanently, BRS are made from materials that dissolve naturally after their job is done typically within two to three years.
Prevention of Re-narrowing of artery: Like drug-eluting stents (DES), BRS can also be coated with medication to prevent the re-narrowing of the artery, known as restenosis.
Restored Vascular Function: Once the scaffold has fully dissolved, the artery regains its natural ability to contract and expand.
Reduced Risk of Long-Term Complications: By using a scaffold that dissolves, BRS minimizes the chances of long term clinical adverse events, making it an ideal solution for young patients who have longer life expectancy.
Flexibility for Future Interventions: As CAD is a progressive disease; younger patients may need further treatments later in life. Without the presence of a permanent metal stent, future angioplasties or other interventions become easier, since there is no foreign object left behind to navigate around.
Drug-Coated Balloons (DCB): Delivering Targeted Therapy without a Permanent Stent
Drug-Coated Balloons (DCB) offers another innovative approach to treating artery blockages, particularly in smaller arteries or in cases where a stent may not be the best option.
Key Features and Benefits of DCB:
No Permanent Implants: Unlike both metal stents and BRS, Drug-Coated Balloons don’t leave any structure inside the artery at all. They function by inflating a balloon within the artery and delivering medication directly to the arterial walls, helping to treat the blockage without the need for any permanent support structure.
Localized Drug Delivery: The balloon is coated with anti-proliferative drugs that are released upon inflation. These drugs help prevent restenosis by stopping the excessive growth of smooth muscle cells within the artery, which can cause re-blockages after treatment.
Treatment for Smaller Vessels: DCBs are particularly useful for treating blockages in small, re-narrowed arteries which were stented before, or difficult-to-reach arteries where placing a stent may not be ideal.
A Young Heart’s Journey with BRS and DCB in Combination: A Tailored Approach
A 52-year-old man, previously unaware of his heightened heart disease risk, faced the unexpected challenge of significant coronary artery blockages. The patient was rushed to a cardiology hospital. While observing the situation and looking at the younger age of the patient, Dr Anuj Bhasin chose to treat the blockage in one of his major arteries, with the BioResorbable scaffold/ dissolving stent, while another smaller artery, which required intervention without the need for scaffolding, he chose to treat with a drug-coated balloon (DCB). This cutting-edge device allowed for artery expansion and direct treatment with medication, without leaving any permanent implant behind.
This patient’s story is part of a broader movement in heart care towards personalized treatments. The combination of BRS and DCB demonstrates how tailored interventions with metal-less angioplasty can significantly improve outcomes, especially for younger patients who have a longer road to maintaining heart health.
Choosing the Right Treatment for Younger Heart Patients
With advances like metal-less angioplasty, younger patients now have more options to treat CAD with minimal long-term impact on their arteries. However, the choice between traditional and metal-less approaches depends on various factors, including the specific characteristics of the blockage and the overall health of the patient. Consulting a cardiologist is essential to determine the best treatment strategy tailored to each patient’s unique needs.
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