Coronary artery disease (CAD) is the most common type of heart disease. This condition is characterized by the narrowing of the arteries that supply blood and nutrients to the heart.
One treatment option for CAD is an interventional procedure called balloon angioplasty. During this procedure, a balloon-tipped catheter is inserted into the narrowed artery and inflated to widen it and restore proper blood flow. Sometimes, a stent is placed to keep the artery open.
People who undergo angioplasty and stenting to treat their CAD may develop coronary in-stent restenosis. In-stent restenosis is when scar tissue forms under the stent, causing the artery to narrow again. This condition is associated with chest pain and adverse cardiac events and occurs in up to 20% of patients after stent placement.
At UPMC, our interventional cardiologists are excited to offer a new, minimally invasive treatment for coronary in-stent restenosis with the AGENT™ Drug-Coated Balloon™ (DCB). The team at UPMC Heart and Vascular Institute in Central Pa. was the first to participate in a national clinical trial evaluating this technology in 2021.
Here, the team at UPMC Heart and Vascular Institute in Central Pa., including Thach Nguyen, MD; Cleon Hubbard, MD; and William Bachinsky, MD, discusses coronary in-stent restenosis and this innovative treatment.
What is the AGENT™ Drug-Coated Balloon™ (DCB) and how does it work?
The AGENT™ Drug-Coated Balloon™ (DCB) is the first coronary drug-coated balloon used to treat in-stent restenosis. During an angioplasty procedure, doctors use this drug-coated balloon catheter instead of a typical uncoated balloon. The drug-coated balloon enables localized drug delivery to reduce the amount of scar tissue around the original stent. This decreases the odds of in-stent restenosis reoccurrence.
What are the benefits of using a drug-coated balloon as a treatment for patients with coronary in-stent restenosis?
Traditional treatment options for in-stent restenosis include a wide range of techniques, including high pressure balloons, specialty balloons, shockwave, laser, radiation therapy, and newer-generation drug-eluting stents. However, many of these treatment options include a metallic layer inside which can lead to recurrent in-stent restenosis. This metal layer decreases the effectiveness of future therapeutic options. This situation is where the drug-coated balloon offers the most benefit based on recent positive data that led to its FDA approval. The main advantage of the drug-coated balloon is the avoidance of an extra layer of metallic stent.
Who qualifies for this procedure?
Any patient with proven in-stent restenosis is a candidate for this procedure. There are various risk factors that increase the likelihood of developing in-stent stenosis, including:
- Chronic smoking.
- Chronic kidney disease.
- Dense buildup of calcium in the arteries.
- Diabetes.
How long does this procedure take and what does it involve?
This procedure typically takes an hour and a half to two hours. Before the procedure, the patient must undergo mandatory heart imaging to determine the best strategy for expanding the old stent. Strategy largely depends on the cause of the in-stent restenosis, which could be an under-expanded stent, ingrown tissue, or scar tissue and plaque buildup inside or behind the stent.
What is recovery like for patients who receive this treatment?
The recovery for this procedure is minimal — similar to a typical stenting procedure. Some patients may stay in the hospital overnight depending on the complexities of their underlying conditions. Most people are free to return to nonphysical labor 24 hours post-treatment and physical labor 48 hours post-treatment.
Why choose UPMC for coronary in-stent restenosis care?
The introduction of this new therapy at UPMC represents a big step forward in our treatment of coronary in-stent restenosis. Our program is committed to providing the highest quality cardiovascular care to patients. This treatment will allow us to continually improve clinical outcomes and quality of life for patients with this challenging condition.
To learn more about our heart care team, or to schedule an appointment, visit UPMC.com/Heart.