Originally created 02/09/02

New technique avoids problems after angioplasty



Three months after angioplasty to open clogged arteries in her heart, Glenda Resch started feeling crummy again.

Climbing stairs left her winded, and stabbing pains shot through her back.

Resch's cardiologist confirmed a common complication: Scar tissue was sprouting inside the recently treated vessels, strangling off the flow of blood.

With open-heart surgery as her only other option, Resch, 59, chose to return to Tacoma General Hospital for a new procedure that uses radiation to zap proliferating scar tissue and keep it from growing back.

Called brachytherapy, the technique is one of several advances transforming treatment of heart disease by tackling a problem that strikes many of the 700,000 Americans who undergo angioplasties each year - including Vice President Dick Cheney.

"This renarrowing of arteries is a huge, huge problem," said Dr. Mark Reisman, director of cardiovascular research at Seattle's Swedish Medical Center. "That's why everybody is so excited about brachytherapy."

Reisman was part of a national team that conducted clinical trials on the new technique. He was the first cardiologist in the country to perform the procedure after the Federal Drug Administration approved it.

Over the past two decades, angioplasty has become one of the most common, major medical procedures in the United States, largely because it's much less traumatic than bypass surgery.

Surgeons inflate a tiny balloon inside an artery plugged with plaque, squashing the fatty deposits against the vessel walls and allowing blood to flow freely again.

But the artery frequently collapses after the procedure, so surgeons usually insert a tiny mesh tube called a stent to prop it open.

In about one out of five patients - Resch and Cheney among them - irritation from the stent triggers the growth of dangerous levels of scar tissue. In March, Cheney underwent the traditional fix: another angioplasty and another stent. If the vice president's luck is similar to the national average, there's a 50 percent chance the artery will close up again.

Brachytherapy improves those odds considerably. Research so far suggests only about 20 percent of patients who get the radiation treatment will have recurring blockages. Longer-term studies are under way, but so far, patients have remained problem-free for up to three years, Reisman said.