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New, free and 'better' stent, but few takers

21-May-2011 (Sat) Home, The Straits Times

By Salma Khalik, Health Correspondent

Just 2 out of 20 suitable heart patients at NUHCS take up offer of the biodegradable stent


 
Associate Professor Tan Huay Cheem (left), showing an enlarged version of the new biodegradable stent - which promises to avoid many of the problems associated with the traditional version - while Madam Tan Soon Mui, one of the first patients here to have the device fitted, looks on. -- ST PHOTO: NURIA LING

PATIENTS here, it seems, do not have the heart to try out a new biodegradable stent even though it is free.

The National University Heart Centre (NUHCS), which is hoping to recruit 10 to 15 heart patients for a clinical trial, has convinced only two out of 20 suitable patients to come on board.

The other 18 have turned down the offer, preferring more conventional stents - about 7,000 a year are fitted here - rather than be among the first in the world to try out a new technology.

This is despite doctors assuring them that the new stent - expected to cost more than $3,000 - could prove to be better.

According to NUHCS director, Associate Professor Tan Huay Cheem, the arteries regain their natural elastic movements after the stents slowly dissolve into carbon dioxide and water over two years.

The patients are also less likely to suffer chronic inflammation or blood clots in those arteries in future.

Clogged arteries can lead to heart attacks, one of the top killers here.

In January, the world's first biodegradable stent was approved for commercial use in Europe, based on results from a trial involving 131 people in New Zealand and seven European countries.

Abbott, the pharmaceutical firm that makes the stent, is extending the clinical trial to 1,000 people worldwide, with a five-year follow-up.

NUHCS is among 100 centres in 25 countries taking part.

Stents are tiny metallic pieces of scaffolding inserted, usually via the groin, into blocked arteries near the heart to keep them open.

The most common are bare metal stents that cost $700 to $1,000 each. But in 30 to 40 per cent of patients, the blood vessel would narrow again at that point within a year. Half of these patients would need a repeat procedure, said Prof Tan.

About 10 years ago, stents equipped with a slow-release drug were introduced, to prevent too much scarring and narrowing of the artery being caused by the presence of the stent.

With such stents, which cost $2,500 to $3,000 each, only about 5 per cent of patients needed to return to hospital for re-stenting.

But with the stent a permanent presence, about 10 per cent of patients need to take anti-platelet medicine for life, and this makes them more prone to bleeding.

And the permanent stent can sometimes cause chronic inflammation. Should the patient require future procedures, the metallic stent could also be in the way.

Hence, doctors have dreamt of stents that would disappear after doing their work, and Abbott has come out with the first viable model.

In Singapore, Madam Tan Soon Mui, 60, in March became the second person to get this stent. She was at first reluctant, not wanting to be a guinea pig, but her daughter convinced her to opt for it.

'Someone has to try out the new things,' said Madam Tan, a part-time furniture trader, yesterday.

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