New treatment for PAD
A multiple stent delivery system enables more specific and flexible treatment for peripheral artery disease.
AFFECTING some 204 million people worldwide, peripheral artery disease (PAD) is not to be taken lightly.
It is strongly associated with coronary artery disease and diabetes, while the risk of developing PAD increases with age and a history of smoking.
A common circulatory problem, PAD is usually caused by plaque build-up (atherosclerosis), resulting in the narrowing of the arteries that lead to the head, organs and limbs, most commonly to the legs, thus reducing the blood flow and causing immobility.
Symptoms include cramping, pain and tiredness in the leg or hip muscles when walking or climbing stairs – all of which ease during rest and return with movement.
“The challenge in treating PAD is that it is usually difficult to detect during its early stages.
“Often, the disease is only noticed when walking becomes very painful for patients, even during short distances.
“For some patients, resting may provide temporary relief. However, the pain would return when movement is involved.
“The pain cycle known as claudication may be the first early signs of PAD,” says consultant cardiologist Dr Shaiful Azmi Yahaya.
“And if left untreated, it could increase the risk of developing critical limb ischaemia, which is a result of inadequate blood supply to an organ or a certain part of the body.
“In more severe cases where there is high fatty deposit build-up in the arteries, a patient may suffer from coronary artery disease, heart attack or a stroke,” adds the National Heart Institute (IJN) Cardiology Department deputy head.
The upside to this scenario? As in all medical issues, a combination of lifestyle modifications and the right medical treatment can play a part to avert any untoward health complications.
Peripheral vascular intervention (PVI) is the preferred first-line treatment technique, particularly for PAD patients with blockages in the main blood vessels of the leg (femoropopliteal lesions).
A non-invasive technique, PVI functions to remove and restore blood flow to the affected artery without the need for surgery.
The doctor conducting PVI creates a small opening in the leg, where a thin, flexible tube (catheter) is threaded through the artery to the affected site.
This catheter serves as a ‘tunnel’ through which the doctor can deliver the necessary tools, such as stents (a type of mesh tube to keep the artery open) to treat the disease.
“Now with this latest breakthrough in PVI, patients stand to benefit from its distinct benefits.
“This new approach allows the doctor to deliver up to six short stents using a single device during PVI.
“Recently, together with my colleague Dr Kumara Gurupparan Ganesan and the visiting head of Angiology and Vascular Medicine from Berlin’s Sankt Gertrauden Hospital, Dr Ralf Langhoff, we performed the first PVI procedure using this new multiple stent delivery system at IJN, making us the first hospital in Asia to do so,” says Dr Shaiful.
This system enables spot stenting (placing short individual stents) only where they are necessary and helps the vessel to maintain its natural movement, especially in the moving segments of the femoropopliteal region.
“This spot stenting procedure can avoid the complications of a ‘full metal jacket’ concept (where the entire affected site is fully covered by a metal stent) in the vessel, which can cause stent fracture (damage), and thereby reduce the treatment’s efficacy.
“The multi-stent delivery system could shorten procedure time, and hence minimise infection risks for patients,” he explains.