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Jefferson Scientists Find Topical Lubrication Effective in Overcoming Obstacles to Cardiac Stent Delivery

RotaGlide™ Lubricant being applied to a stent

A mixture of olive oil, egg yolk and glycerine might be just the recipe to keep heart patients away from the operating room and cardiac bypass surgery.

That’s the finding of a study led by Michael Savage, MD, Director, Cardiac Catheterization Laboratory at Thomas Jefferson University Hospital, Philadelphia.

The mixture is not swallowed, Dr. Savage explains. Rather, it is used in the Cardiac Catheterization Laboratory to bathe surgical stents before they are inserted into problem heart arteries.

How stents have evolved
Since being introduced in 1994, stents – the metal mesh tubes placed in a coronary artery to keep it open after an interventional procedure – have worked in the majority of patients.

Coated or drug-eluting stents that prevent restenosis (the re-closing of the artery a short time after stent insertion) were the next advance in this field.

“There are still a small number of patients with arteries that cannot be stented because of anatomic obstacles,” says Dr. Savage, who is also Associate Professor of Medicine, Jefferson Medical College of Thomas Jefferson University. “In these patients, bypass surgery is often required as an emergency life-saving procedure.”

One such obstacle is tortuosity (extreme bends in the vessels leading to and from the coronary artery), which taxes the limited flexibility of stainless steel stents. Dr. Savage likens attempting to place a stent through a tortuous vessel to “trying to move a couch around a narrow stairwell.”

Other obstacles are calcification, which hardens bones, and diffuse plaque, which can make the vessels too rigid for effective stent delivery.

Establishing safety and effectiveness
The cardiologists tested the emulsion in a group of 15 men and five women between the ages 60 and 80. These patients had abnormal arteries that were oddly shaped or winding or had particularly tight blockages and, therefore, could not be stented. After failed conventional attempts to deliver stents, the Jefferson physicians were able to place the lubricated stents successfully in 17 (85 percent) of these patients with no negative effects months after the procedure.

The mixture used was RotaGlide™ Lubricant, manufactured by Boston Scientific of Maple Grove, Minnesota for a completely different purpose: to reduce catheter friction during rotational atherectomy, a plaque-removing procedure.

Dr. Savage

Dr. Savage credits the initial idea for using RotaGlide to lubricate stents for easier delivery to a 2004 case report from the Oshner Clinic in New Orleans. In turn, he and Adeeb Ahmed, MD, who, at the time was an interventional cardiologist at Jefferson, tried it successfully on one patient on whom all other techniques for stent delivery had failed.

To assess the biocompatibility of the lubricating RotaGlide™ solution with often-used drug-eluting stents, the researchers studied additional patients for a longer follow-up period. None of the patients who received the drug-eluting stents developed blood clots or restenosis.

“We found that this emulsion is a safe, simple and effective aid for stent delivery in the rare cases where stents could not previously be inserted,” Dr. Savage said.

Spreading the word
In addition to Dr. Savage and Dr. Ahmed, members of the team of interventional cardiologists who conducted this study at Thomas Jefferson University Hospital in Philadelphia included Alok Singh, MD, Mark Awar, MD, Paul Walinsky, MD, and David L. Fischman, MD.

Earlier this year, Dr. Singh presented the results of their study at the American College of Cardiology Annual Conference in Atlanta. The Jefferson team has since written a more detailed paper that has been submitted to a leading cardiology journal so that more clinicians can learn about and apply this technique of lubricated stents for patients as an alternative to emergency bypass surgery.

Angiogram showing multiple severe coronary blockages, indicated by arrows

Angiogram after successful angioplasty and placement of lubricated stents