Thursday, June 7, 2001

Esther Misajon was the first in the state to have an angioplasty
with a new drug-coated artery stent that dramatically reduces
failure rate. Her artery was 90 percent blocked before the
May 7 surgery, which was performed by Dr. Danelo Canete.
Now Misajon says she is feeling great and plans to go to
Las Vegas in July to see her granddaughter.

Treatment gives
heart patient hope

A new procedure helps reduce
possible risks of blood clotting

By Helen Altonn

Esther Misajon, 75, of Ewa Beach says she feels "like a new person" after being the first to undergo a new coronary artery procedure at St. Francis Medical Center.

She is back to gardening and walking and plans to go to California later this month for a grandson's high school graduation.

She is also going to Las Vegas in July to watch her granddaughter, Maile, perform with the all-girl group Eden's Crush, opening for 'N Sync.

Misajon was cardiologist Danelo Canete's first patient to receive a stent with a special drug coating that prevents development of blood clots.

Misajon's artery -- 90 percent blocked before the May 7 procedure -- was 100 percent clear in later checkups.

An angioplasty procedure involves threading a catheter into the narrowed portion of an artery and inflating a small balloon. This compresses the fatty buildup against the artery's wall and enlarges the channel where blood flows.

A stent, or tiny mesh tube of metal, may be used to help prop the artery open like scaffolding.

The angioplasty procedure must be repeated, or bypass surgery performed, if the blood vessels narrow again.

Canete said cardiologists are very excited about the stent coated with the drug heparin because "plain old balloon angioplasty, going on since 1984, had a restenosis (re-narrowing of the blood vessels) rate of 50 percent, which means 50 percent of all cases we do within six months close down, and we have to go back and fix it."

Stents reduced the re-narrowing rate to 20 or 30 percent by allowing bigger openings in the vessel, he said. And the latest models this year reduced the rate further, to 18 percent or 19 percent, "which is pretty good compared to 50 percent," he said.

"Now, this little puppy (drug-coated stent) came along and has reduced it to 4.6 percent."

Cordis Corp., a Johnson and Johnson Co., developed the heparin coating, a blood-thinning agent used to reduce risks of clot formation. It is the first drug-coated stent approved by the Food and Drug Administration.

Canete said there is a savings both in cost and trauma to patients by not having to have the angioplasty redone.

He said Misajon "just happened to be the lucky one that got the first one" at St. Francis Medical Center. "There was a big smile on her face."

Now, he said, "we make sure we're not following the same road that got her there in the first place." Generally, it is a composite of high blood pressure, cholesterol and diabetes, he said.

"I'm very conservative. I feel the disease is not really coronary or carotid or a renal artery disease. I feel it is a disease of all arteries. I believe in systemic treatment," he said, describing effective new drugs.

Misajon, born and raised on the Big Island, had lived in California since 1960 and moved back here in February.

She bought a home at Ewa Beach so her four children, seven grandchildren and two great-grandchildren will have a place to stay if they come to Hawaii.

She said she was being treated on the mainland for atrial fibrillation, irregular heart rhythm. She immediately began looking for a doctor after moving here and was referred to Dr. Canete.

"I just adore that man," she said. "He is so knowledgeable. His hands are so tender ... and he's very much concerned."

After tests showed she had 90 percent blockage in an artery, she said, "He told me what I could do to help clear it. One is angioplasty. The other, if anything happened while doing it, would be open heart surgery.

"My God, I was so worried. I was devastated by the news. I was worried, what am I going to do?"

Canete told her in detail what he was going to do, she said. He was also concerned about making sure her family knew what was happening and explained the procedure to one of her granddaughters, a doctor in residency at the University of California at Los Angeles. She explained it to others in the family.

Misajon said Canete "had standby doctors in case of complications, in case he had to do open heart surgery."

However, no surgery or cutting was involved, she said. "This procedure goes through your vein. How he does it is beyond me. It's unreal. I didn't feel anything and had no vomiting or aftereffects."

She was kept in the hospital one day as a precaution because of her irregular heart, she said.

But, she said: "The very next day after I got home, I went for a walk. I never realized how wonderful this procedure is. By golly, I tell you it's fantastic. I cannot believe how I feel.

"I have so much energy now, and I forget myself. I'm out in my garden working, and all of a sudden I feel little pain. I go in the house and do a little resting, and I'm out again. I'm just a new person."

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