• Absorb: the First Fully Absorbable Vascular Stent

    Available in the Tri-Cities only at the Wellmont CVA Heart Institute


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  • Heart institute patients will be among the first in the nation eligible to receive a new type of device to open clogged heart arteries. One that eventually dissolves, leaving no trace it was ever used.

    The good news for Tri-Cities area patients is the Wellmont CVA Heart Institute, as the leading enroller nationwide in clinical trials for this new technology, is among a very limited number of U.S. sites to be able to offer it initially.

    Heart disease and heart attacks

    Heart disease is the leading cause of death in the United States, causing one of every four deaths each year.

    And coronary heart disease (CHD) – often called coronary artery disease (CAD) – is the most common type of heart disease.

    In fact, more than 2/3 of all heart disease deaths are caused by CAD. In just one recent year, that added up to 405,309 victims.

    What is coronary artery disease?

    In CAD, the arteries that deliver blood to the heart become narrowed or blocked by a build-up of fatty deposits called plaque.

    When arteries narrow like this, the blood flow to the heart muscle is reduced. This limits the oxygen that’s able to get to the heart, making it harder for the heart to work properly.

    If the artery is completely blocked, areas of the heart muscle can be damaged – or even die – which can lead to a heart attack.

    How is CAD treated?

    Coronary artery disease can be treated in a number of ways, including angioplasty and coronary stents.

    Angioplasty

    Angioplasty is one way physicians can widen blood vessels that have narrowed or become obstructed by plaque buildup. During angioplasty, an empty, collapsed balloon – also called a balloon catheter – is passed over a wire into the artery and then inflated to the diameter of the artery.

    The balloon pushes back the plaque and opens up the blood vessel so the blood can flow normally again. The balloon is then deflated and pulled back out.

    Conventional heart stenting – metallic stents

    In some cases, a small mesh tube called a heart, or coronary, stent is used with angioplasty to keep the diseased blood vessel open after the procedure.

    The most commonly used type of stent has been a medicated or drug-eluting metallic stent.

    Because these metal stents are implanted permanently, they do have some serious possible complications: they can limit artery flexibility and may cause inflammatory reactions, thrombosis or restenosis.

    Patients with metallic stents also have to take two blood-thinning drugs (anticoagulation therapy) the rest of their lives. This is necessary to help prevent blood clots from forming on top of the stent.

          But now, there’s an alternative to permanent stents…

    Advanced heart stenting – new bioresorbable stent

    A stenting device called Absorb is the first nonpermanent implantable stent offered in the U.S.

    Unlike the conventional metal stent, Absorb uses a non-metallic mesh tube.

    This tube is made of polylactide, the same type of material used in other medical devices such as dissolving stitches.

    Sometimes referred to as a bioresorbable vascular scaffold system, Absorb treats coronary artery disease by opening the narrowed artery to restore blood flow to the heart, much like a metal stent.

    What’s the difference?

    The difference – and we think it is a really big difference, if not a revolutionary one – is that once the artery has the ability and strength to stay open on its own, the Absorb stent gradually and completely dissolves away, leaving mostly just water and carbon dioxide.

    Just think about it: after a few years, about all that’s left of the stent are basic natural substances already found in our bodies.

    The only other components that remain are two tiny markers. Measuring just 200 micrometers in diameter, these markers are designed to help doctors locate the implantation spot in the future if they need to.

    The Absorb stenting procedure is minimally invasive surgery that provides:

    • Great results – similar to conventional stenting in the short term
    • Minimal side-effects
    • No need for the ongoing use of two different blood thinners after the stent dissolves, when an aspirin-only treatment will be an option
    • Potential elimination of the long-term risks – such as scar tissue and blood clots – associated with a permanent stent

    Where did the concept for a dissolving stent come from?

    The Absorb bioresorbable stent was developed with the understanding that a stent, as well as drug delivery to a diseased coronary vessel, are really only temporarily needed after a coronary procedure.

    Several studies support this idea and suggest that, in most cases, a permanent implantable stent doesn’t offer any benefit over time.

    How does Absorb work?

    Unlike a metallic stent, Absorb is more flexible and fully dissolves over time, starting 3 to 6 months after the implantation.

    Without a permanent implant, the Absorb-treated blood vessel has the potential to flex, pulse and dilate in response to demands on the heart caused by lifestyle and activities such as exercise.

    3 phases of vascular reparative therapy with Absorb

    Absorb was designed to work in three phases to deliver what's called vascular reparative therapy (VRT):

    • Phase 1: Revascularisation – restoring blood flow
      First, Absorb restores blood flow in the same way the best drug-eluting stents do. Absorb achieves this, in part, through the slow, controlled release of everolimus (a drug that helps prevent restenosis) to the diseased artery. Restenosis, or recurring stenosis, is basically an abnormal narrowing of the artery.
    • Phase 2: Restoration – restoring the artery itself
      This phase restores the blood vessel to its natural state for better long-term outcomes.
    • Phase 3: Resorption – dissolving the stent
      As the stent degrades, it gradually stops supporting the artery. During this process, the polymer the stent is made of is converted to lactic acid, which ultimately converts into carbon dioxide and water. This process can take up to 3 years.

    Who is eligible for Absorb?

    Appropriate for most patients, but not all

    The Absorb bioabsorable stent is appropriate in most cases where a patient has a blockage. However, in some cases – such as when very small arteries need to be opened up – a conventional medicated metal stent might be the best option.

    Each case will need to be reviewed individually by an interventional cardiologist, who can determine which type of stent is the most appropriate.

    Cost and insurance coverage

    The cost of the Absorb stent for patients and insurers is about the same as the cost of a standard metal stent.

    You may need to check with your insurance provider for specific details about your coverage.

    Where is Aborb offered? Why should I choose Wellmont?

    One of only a few Absorb Centers of Excellence nationwide

    The Wellmont CVA Heart Institute is a Center of Excellence for advanced interventional procedures.

    And as a Center of Excellence, the heart institute and Holston Valley Medical Center are among very few sites in the country with initial access to the Absorb stent.

    No. 1 enroller in the Absorb clinical trial

    The heart institute was the No. 1 enroller of patients – 141 to date – in the ABSORB III and ongoing ABSORB IV clinical trials.

    In fact, Dr. Chris Metzger, MD, a interventional cardiologist who is medical director of the heart institute’s research program, was one of 15 physicians to write an article in the New England Journal of Medicine on the ABSORB III trial. This publication is the leading medical journal in the world.

    The most experience with Absorb across a very large region

    Absorb is just now hitting the U.S. But with our clinical trial experience, we already have extensive experience with the Absorb implant procedure, which is somewhat different from metallic stent implantation.

    That experience, combined with our highly skilled interventional cardiology team and sophisticated catheterization labs, make the heart institute an excellent choice for the treatment of coronary heart disease.

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