Coronary procedure
keeps Maui man goingA small stainless-steel tube
is placed in a blocked artery
to open it for better blood flow
Takayuki Harada had just read about federal approval of a new coronary procedure when he had an opportunity to be the first patient to get one at Straub Clinic & Hospital.
Now the 62-year-old Maui man is back to yardwork and fishing with no worries that his artery will be clogged again in a few years.
"He was pretty fortunate," said Dr. David Lee, the cardiologist who performed the interventional surgery.
He said the moment the federal Food and Drug Administration approved the new stent April 24, Straub had it rushed here. It arrived in time for Harada's surgery April 28.
A stent is a small stainless-steel tube placed in a blocked artery to open it for improved blood flow through the vessel.
Many hospitals now are using the CYPHER Sirolimus-Eluting Coronary Stent, which dramatically reduced re-blockage of a coronary artery in clinical trials. It is considered one of the most significant advances in the history of cardiology.
"It's quite exciting," Lee said, explaining the restenosis, or tissue regrowth, rate from balloon angioplasty alone is 30 to 40 percent.
It is about 15 percent with stainless-steel stents and probably down to 2 percent with the new drug-coated stent, he said. "It's a major breakthrough."
The CYPHER stent releases the drug sirolimus to reduce cell regrowth. The drug formerly was known as Rapamycin, originally a chemotherapy agent isolated from Rapa Nui (Easter Island), Lee said.
Dr. Roy Chen, chief of cardiology at Straub, said the drug is bound to a polymer coating on the stent that controls timed release of the drug inside the vessel over roughly one month.
One of the major problems with conventional "bare stents" is that they can actually stimulate cell growth within the stented segment, he said.
So while a stent procedure opens up a blocked artery, it can be lost within six months to a year due to rapid cell growth into the stent, he said. Some patients undergo radiation or brachytherapy with some success, but some eventually require bypass surgery, Chen said.
The drug released by the new stent arrests cell growth but does not kill cells, he said. "It would not be zero restenosis, but in two years' follow-up it was close to it."
Tissue regrowth after a coronary procedure has been the "Achilles heel of angiopasty," Lee said.
The metal stents introduced in the 1990s helped with re-blockage but did not prevent muscle cells from growing back, he said.
The drug released by the new stents "slowly elutes into tissue and prevents smooth muscle cells from growing through the stent," he said.
"It's a great thing for patients," said Karen Lemieux, director of Straub's Heart Center. "Not only will it save lives, but the patient won't have to go back into the hospital again, either for open heart surgery or another stent procedure."
Harada said he thought he had indigestion when he had a pain in his chest April 26, but it did not go away. "I just had kind of a funny feeling I needed to call 911. I don't know why."
One sign may have been his dog, which "started to run crazy around me," he said.
Even when he arrived by ambulance at the hospital, he said, "I didn't think I was having a heart attack." Tests showed, however, that he was having a mild heart attack, and he was sent by air ambulance to Straub in Honolulu.
Harada, former manager of the Maui office of Occidental Underwriters, said he feels "real fine" and has "pretty much resumed normal activities."
He said he is "kind of excited" about having the new stent. With chances of re-blockage dramatically lowered, he said, "At least, until I die, I can still go."
Currently, there are limited sizes and short supplies of the new stents, so conventional ones still are being used during the transition, the cardiologists said.
The new stents also are three times more expensive, Chen said, adding the hope that competition among companies may lower the price.