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Physicians know that drug-eluting stents are an effective way to ensure that a patient’s arteries will remain open after balloon angioplasty. They also know that these devices have their limits—especially in keeping open bypassed vein grafts with longer blockages. It is for these vessels, researchers at Jefferson Medical College say, that physicians should consider alternative treatment strategies.

A new study by researchers at Jefferson Medical College looked at the effectiveness of drug-eluting stents in keeping open native (original) heart arteries and saphenous bypass grafts (bypassed heart arteries) with diffuse disease. Diffuse disease means that the artery is much more clogged and therefore at greater risk of re-clogging.

“We already know the effectiveness of these stents in preventing restenosis (a condition where scar tissue grows in heart arteries that were previously opened by balloon angioplasty) in arteries that aren’t diffusely diseased or have too many lesions,” explains Michael Savage, M.D., director, Cardiac Catheterization Laboratory at Thomas Jefferson University Hospital, Philadelphia.

The Jefferson researchers looked at the success of drug-eluting stents in both native coronary arteries and bypassed vein grafts and found that long-term success was dependent on both the healthiness of the vessel as well as the type of disease—focal (shorter lesions) or diffuse. Lead researcher Parul Patel, M.D., a fellow in cardiovascular diseases, will present the results on Thursday, May 10, from 12:30 to 4 p.m. at the Society for Cardiovascular Angiography and Interventions in Orlando.

“Knowing that drug-eluting stents are effective in preventing restenosis in arteries with focal disease, our study concentrated on patients with diffuse disease,” Dr. Savage, who is also associate professor of Medicine, Jefferson Medical College of Thomas Jefferson University, explains.

Eighty five patients --64 men and 21 women with a mean age of 63 years--were treated with drug-eluting stents in the Cardiac Catheterization Lab of Thomas Jefferson University Hospital. These patients were characterized as having diffuse disease because they had more than 30 millimeters of disease or three or more lesions in a single artery.

All patients were continued on aspirin and clopidogrel (Plavix) for at least one year after the procedure. After 17 months, 91.3 percent of patients with drug-eluting stents in native vessels remained free of clinical restenosis (re-clogging). In bypassed graft patients, 29.8 percent remained free of the need for a repeat procedure on that graft.

“Importantly,” says David Fischman, M.D., associate professor of Medicine, Jefferson Medical College of Thomas Jefferson University, “in both groups, there were no incidents of dangerous blood clots.”

“This study confirms that for patients who have diffuse disease in bypassed heart grafts, alternative therapies should be considered,” says Dr. Fischman, who is also associate director, Cardiac Catheterization Laboratory at Thomas Jefferson University Hospital. “In native vessels, however, the therapy remains a good alternative to bypass surgery.”