Cardiology Stem Cell Therapy Offers Cardiac Repair

Cardiology stem cell therapy offers great hope and is the topic of much discussion. Currently, basic research scientists and clinicians worldwide are investigating human embryonic cardiac stem cells, skeletal stem cells (myoblasts), adult bone marrow stem cells, cardiology stem cells and human umbilical cord stem cells for the treatment of patients with MIs and ischaemic cardiomyopathies.ÿWhilst important progress is occurring in the use of stem cells for cardiac repair, the most optimal stem cell(s) for treatment of patients with infarcted myocardium is yet to be determined.

At present, there are no widely used stem cell therapies other than bone marrow transplant. Research is underway to develop various sources for stem cells and to apply them to heart disease and other conditions.

Another exciting area is the field of stenting. The introduction and widespread adoption of drug-eluting stents into routine clinical practice has seen tremendous changes in the practice of interventional cardiology. For a prolonged period, manufacturers have focused research on drugs and polymers that are the key to the prevention of in-stent restenosis. However, stent platform design and its clinical implications have now come back to the fore. Manufacturers and clinicians will have to work closely in partnership to makesure that stenting devices can provide excellent safety and long-term efficacyfor patients.

Cardiology associates should have a complete understanding of the design features of the devices that they are implanting. It is likely that LMS PCI and the treatment of large vessel bifurcations will become a mainstream application of PCI over the forthcoming years and manufacturers may need to consider producing dedicated platforms for the treatment of these vessels. As more patients with multivessel disease are treated greater attention will also need to be placed on longer-term outcomes in more demanding clinical settings, an area aboutwhich cardiology associates will need to be kept up-to-date.

The risks of latent stent fracture may assume a more prominent role in clinical studies in future. Ultimately, as the clinical practice of PCI continues to evolve, manufacturers and clinicians will have to work closely in partnership to make sure that the stenting devices that are implanted can provide excellent safety and long-term efficacy for patients. The importance of stent design has been re-emphasised and is likely to become increasingly relevant in future, where the patient and lesion being treated are likely to mandate very careful selection of the stents that are deployed in each individual setting. The focus should be shifted away from producing ever more deliverable stent platforms and should be moved back to the fundamental properties of what the device has been built to achieve.

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Drug-eluting balloons more successful than other treament in coronary restenosis

Drug-Eluting Balloons (DEBs) are conventional semi-compliant angioplasty balloons covered with an antirestenotic drug which is released into the vessel wall during inflation of the balloon, usually at nominal pressures with a specific minimal inflation time. The active substance on the Drug-Eluting Balloons should be lipophilic enough to have a high absorption rate through the vessel wall to compensate for the short period of contact between the inflated balloon and the vessel wall itself, and to maintain a sustained effect once released.

Percutaneous treatment of complex coronary lesions, such as small-vessel heart disease, diabetes and long diffuse disease, remain hampered by suboptimal results, even with the use of drug-eluting stents (DES). The DEB is an interesting emerging device in the field of heart disease that optimises clinical outcomes in these specific lesions. The DEB may become a viable alternative treatment option for the inhibition of coronary restenosis and subsequent revascularisation, as it allows local release of a high-concentration antirestenotic drug, paclitaxel, into the coronary vessel without using a metal scaffold or durable polymers.

Several studies have already shown promising and consistent results in the treatment of in-stent restenosis. The DEB has demonstrated its added value compared with certain DES. Inspired by these results, an increasing number of studies have been started in different coronary lesion subsets to explore the value of the DEB in a broader range of lesions. It will be interesting for cardiology associates to see whether the DEB will find more indications beyond in-stent restenosis treatment. Moreover, will all DEBs offer the same added value, or will there be differences in efficacy among the DEBs produced by the various manufacturers? As was the case in the development of DES, now the puzzle pieces have to be put together for DEB. Potentially more good news on the horizon for cardiology associates.

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