Some people are more prone to heart attack and some less. These depend upon some characteristics of patients called risk factors; these are smoking diabetes, increased cholesterol, high blood pressure, obesity and lack of physical activity

Development in any sector usually happens in a steady way. When it happens in milestones it appears like a miracle. Recent advancement in the field of cardiology has happened in a similar manner. The latest development has also happened like  a miracle—namely bioabsorbable stent.

Coronary artery disease develops when the arteries that supply blood to heart become narrowed with fatty deposits. With time the fat deposits get bigger and the blood flow decreases. When the lumen gets significantly narrowed the patients get chest pain on exertion; the patient may just complain of chest heaviness, shortness of breath, pain in jaw or shoulder, heartburn, nausea, vomiting. If associated with sweating these symptoms have to be taken more seriously. Furthermore, when a vessel is completely blocked the patient has a heart attack. He or she has severe chest pain like never before for more than 20 minutes, usually associated with sweating; he or she may or may not collapse. Sometimes all these may go silent without any symptoms, diagnosed later just by other tests like ECG or echocardiography.

Some people are more prone to heart attack and some less. These depend upon some characteristics of patients called risk factors; these are smoking, diabetes, increased cholesterol, high blood pressure, obesity, lack of physical activity, sedentary lifestyle, old age, family history of heart attack etc.

The history of angioplasty started in 1977 when the first angioplasty was done. In 1986 bare metal stenting era started and in 2001 drug eluting stents (DES) were introduced. All these developments are regarded as different milestones in the history of CAD treatment. When a heart attack was first time treated with angioplasty it was regarded as a miracle.

In angioplasty a small balloon is inflated within the narrowed portion of a blocked artery pushing the plaque against the artery wall and improving the blood flow in the coronary arteries. But with time, it was noted that the vessel got closed very soon and often.  The metallic mesh tube called stent was then developed, mounted on a balloon and delivered to the narrowed portion of an artery. It worked as a scaffold and stopped the artery from closing immediately. These stents did help initially but with time there was growth of tissues from the inside of the vessel and had narrowing of the vessel soon in 20-30% of the cases.

Drug eluting stent was then developed. It had a metallic scaffold which had drug coatings. These drug coatings prevented the growth of tissue from the inner linings of the artery, thus it prevented narrowing of the artery. But the metallic scaffold remained inside the artery lifelong as a foreign body.

It is something like melting sutures which disappears from the wound once the lesion is completely healed. But this does not mean that the DES stents are equivalent to unremoved stitches of the wound.

Angioplasty procedure is performed in a special room at a hospital called a cath lab. The place on the body from where the access is gained to coronary arteries (groin or wrist) will be cleaned and shaved and local anesthetics given to numb the area. The whole procedure will take about an hour. The patient remains awake during the procedure. The doctor locates the lesion of the artery by using x-ray for implantation of stents.

Bioresorbable vascular scaffold is the latest advancement in treating CAD. BVS is designed to help open up a blocked artery in the heart and restore blood flow to the heart muscle. BVS gradually dissolves once the artery is able to stay open on its own, potentially allowing the vessel to function naturally again.

BVS is made of a material commonly used in other medical devices such as dissolving stitches. This material allows BVS to break down into elements already found in your body: water and carbon-dioxide. Being treated with BVS means you do not have a permanent implantation which allows your artery to resume a more natural function. BVS may also benefit you in the following ways:  eliminate the concern about a permanent implant, help to reduce the chances of future CAD and make the complicated procedure easy and less complicated. It also gives the treating doctor more options for  care. Moreover if further treatment like bypass heart surgery is needed in future, it does not hinder the procedure because of the permanent implantation of steel structures which cannot be dissolved like a BVS.

Present studies show that there are a lot of problems in deploying the metallic scaffold stents especially in branch lesions. The burden of metal mass, which remains, exposes the vessel to sudden closure in nearly 1 % of all patients each year due to clot formation. And this is an alarming risk and a nightmare for both the patient and the doctor because this often results in sudden death.

Branch lesion known as bifurcation lesion is regarded as a difficult treatment in the field of interventional cardiology. So with the invention of the dissolving stent all these problems may be solved easily; the stents we are using at this date may become obsolete, thus BVS in interventional cardiology is a miracle. And this will be a big asset in fulfilling the world heart day theme of a heart healthy environment.

Rajbhandari is a senior cardiologist at Vayodha Hospital

(This online version corrects the name of author. Mistake in the print edition is regretted. - Ed)