April Meeting at JSUMC

As Chapter President Bill Ryan opened the meeting, Ed Diamond (manager of cardiology at Jersey Shore) explained that the previously announced speaker couldn’t make it, and Joe Vellucci had graciously stepped in. Joe comes to us from Medtronic, one of the vendors for the cath lab. Joe began his talk by ascertaining that most of us already have stents, and went on to give some of the history of Medtronic, which he said started in 1949 with an electrical engineer married to a nurse, leading by 1956 to the development of an implantable pacemaker, Medtronic’s first product. Medtronic, Joe said, is now the world leader in medical devices, with a focus on the heart.

Joe explained that angioplasty started in 1977 as an alternative to opening the chest to do bypass surgery. Instead, a catheter is threaded from the femoral artery into the blocked coronary artery. A balloon is inserted through the catheter into the blocked artery and inflated to widen the artery from inside. But too often the effect was short-lived; after a while the artery collapsed closed up again.

The obvious solution to that problem would be to hold the artery open by leaving a scaffold - a stent - inside the artery after opening it. The first stent was used in 1986. It was made of steel, slipped over the balloon and expanded by inflating the balloon.

But there was still a problem. The arteries didn’t collapse, but in nearly half the cases an inflammatory response would cause tissue growth inside the artery that closed it up again, a process called restenosis. In 2001, Cordis, a J&J company, introduced drug-coated stents, with a polymer coating over the bare metal carrying a drug that would be eluted into the tissue of the artery, slashing the rate of restenosis from 20 – 30 percent to 4 – 6 percent. This technology is constantly being improved. Stainless steel has given way to cobalt alloy, and one competitor is coming out with a biodegradable polymer stent.

With drug-eluting stents another problem is stent thrombosis - formation of a clot inside the stent. Patients with drug coated stents have to take Plavix for the next year or so to prevent thrombosis.

Joe passed around a model of a stent to show its structure, and a real stent, which is too small for our aging eyes to see clearly. As we looked at them, Joe pointed out that stents of different types can be used in different parts of the body - leg stents for peripheral artery disease, biliary stents, renal stents, stents in the carotid arteries, in the aorta, and so on.

Stents come in about six standard diameters and different lengths. As Joe explained, typically they do a femoral artery stick in the groin and insert a guide catheter, using X-rays to see where it’s going. A smaller catheter is threaded through the guide catheter carrying the stent on a balloon. A simple inflation device pushes a radio-contrast liquid into the balloon, so they can see what’s happening, and the inflation pressure controls the size to which the stent is expanded.

Joe pointed out that it’s not a simple matter to second-guess whether stenting or bypass should have been done in any particular case. It’s the doctors’ decision, depending on how many arteries are involved, among other factors.

After Joe answered a lot of questions, Bill introduced Jack Beerman to give the official report on the results of the chapter elections - with thanks to both Jack and Rita for their work to help make that happen.

Jack reported that 59 votes had been received from about 130 eligible voters, and urged people to be more active in the chapter. Of course the result was never in doubt. Bill introduced Matthew Klug, the President-elect, noted that Vice-President-elect Rick Steelman couldn’t attend a daytime meeting, introduced Treasurer-elect Neil Paulsen, and reminded us that we still need a Secretary to replace Lois Landis, who’s been working at it for too long.

Outgoing Vice-President Len Talalai repeated the plea for more participation, since the currently active members can’t continue forever; Neil Paulsen reported progress on a program to visit stent patients, which would require more volunteer visitors; and Matt Klug reinforced the plea for more members to become active.

The next meeting at JSUMC will be a 6:00 pm meeting in June.