Dr Joaquin Azpilicueta
Medical Director Iberia and Latin America, Elixir Medical
New arterial implants are revolutionising atherosclerosis treatment. Unlike stents, they promote normal vessel function and decrease the risk of major adverse coronary events.
Coronary artery disease, caused by atherosclerosis, can be fatal. It occurs when fatty material (atheroma) builds up inside the arteries, which transport blood around our bodies. If this plaque blocks or narrows an artery and restricts blood flow, it can result in heart attack.
Modifiable vs unmodifiable atherosclerosis risk factors
Various risk factors increase a person’s chances of developing atherosclerosis, explains Dr Joaquin Azpilicueta, Medical Director, Iberia and Latin America at cardiovascular technologies company, Elixir Medical. “Some of these are modifiable, such as eating a healthier diet, stopping smoking and ensuring hypertension is well-treated,” he says.
“Other risk factors are unmodifiable. For example, genetic factors can play a part in progression of atherosclerosis. So does being male. Then there’s the ageing process because, just as our skin gets dry and thin with age, our vessels deteriorate in their own way.”
Stent technology advantages and drawbacks
Thankfully, significant medical advances have helped patients with coronary artery disease. These include a minimally invasive procedure known as a percutaneous coronary angioplasty (PTCA), which holds blocked or narrowed arteries open with a wire mesh tube called a stent, improving blood flow.
Yet, as groundbreaking and lifesaving stent technology has been, it does have drawbacks. “It’s not a perfect solution,” admits Dr Azpilicueta. “After the procedure, the healing process in the inside of the artery leaves a scar, which can further restrict blood flow. This is why drugs are put into stents to prevent excessive scar tissue growth — an extremely successful development.”
With a bioadaptor implant, plaque volume
decreases in patients with lipid-rich lesions.
Addressing stent limitations to preserve arterial physiology
Another, more subtle, problem is that stents are rigid structures. “They act like a corset,” notes Dr Azpilicueta. They ‘cage’ and constrain the normal functions of an artery and affect its ability to dilate, pulse, twist and flex. Unfortunately, this unnatural rigidity can affect the function of hormone-producing cells, which have a positive impact on an artery’s function and health.
“As a result, a stented artery is more prone to develop atherosclerosis than a native artery,” says Dr Azpilicueta. “This increases the risk of the patient experiencing further major adverse coronary events (MACE) over time. So, the cardiovascular community has been seeking to develop implant solutions that preserve the physiological nature of an artery, thus improving its vital cell function and overall health.”
Introduction of a groundbreaking vascular implant
That’s why there is excitement about a new, recently approved technology called a bioadaptor, developed to replace stents in an important number of patients. Like a stent, a bioadaptor is implanted via the same minimally invasive procedure and left behind in the artery to hold it open.
However, it is fundamentally different in composition because it’s made of three separate helical strands, which are temporarily interlocked and joined by a bioabsorbable material. This disappears in six months as new artery muscle and hormone producing cells grow around it; then, as the strands separate and become a flexible and dynamic structure of the vessel wall, the artery is able to recover its pulsatility, flexibility and plasticity (adaptability of an organism to change in its environment).
Bioadaptors help prevent major adverse coronary events
“This solution is strong enough to keep the artery open but gentle enough for its physiology to play a significant role in expanding the life and health span of our patients,” says Dr Azpilicueta.
Plus, it offers another major gain. “In a controlled trial, we observed that, with a bioadaptor implant, plaque volume decreases in patients with lipid-rich lesions,” reveals Dr Azpilicueta. “In comparison, stented arteries record an increase in plaque volume. Taking all these benefits into consideration, we expect bioadaptor technology to contribute to a significant reduction of MACE in the mid to long-term compared to stents.”
