The Dutch Zuyderland Medical Centre claims to be the first hospital in the Benelux to be able to insert a soluble, drug-coated stent in patients with narrowed blood vessels in the lower legs. The stent is designed to prevent renewed blockages and reduce the need for follow-up operations. Every year, more than a thousand patients undergo angioplasty at Zuyderland. After angioplasty, lower leg blood vessels often close again, causing symptoms to persist and sometimes requiring invasive surgery. Zuyderland hopes to reduce this problem with the new stent.
Every year, more than 1,000 patients undergo angioplasty treatment at Zuyderland. This large number makes it possible to conduct targeted research into improving and personalising this procedure, especially for narrowings in the lower legs. Thanks to the large number of patients, researchers can systematically investigate which patients benefit most from the dissolvable stent and how the treatment can be further personalised to make procedures less risky and more sustainable.
Camera
To further improve the quality of this care, Zuyderland is investigating how the blood vessel can be visualised even more precisely during treatment. Using Optical Coherence Tomography (OCT), a tiny camera in the blood vessel, doctors can determine exactly how large the blood vessel is and which treatment is most appropriate. This increases the chance of a lasting good result.
The new dissolvable stent keeps the blood vessel open for a longer period of time and then dissolves completely, leaving no permanent implant behind. This is expected to result in fewer recurrent narrowings, fewer bypass operations and a decrease in the number of amputations. With this first and the ongoing research, Zuyderland is taking an important step towards more personalised and future-proof care for patients with vascular disease.
Coronary arteries
At another Dutch hospital, Albert Schweitzer Hospital (ASZ), 117 patients will have a biologically dissolvable stent placed in one of the coronary arteries around the heart this year. This is part of the Perfect Restore scientific research project set up and conducted by the cardiologists at ASZ. Stents have been used for many years to remedy narrowing in the coronary arteries.
‘Until about ten years ago, there were also soluble variants, but they were not satisfactory and were withdrawn from the market. We now only use permanent metal stents. These may have disadvantages in the long term,’ explains interventional cardiologist Jin Cheng of ASZ.
Cheng and his colleagues see particular advantages in a dissolvable stent that is eventually broken down completely by the body. The starting point is a solution that leaves no foreign material behind, while at the same time being safe, strong and compliant with the applicable requirements. The cardiologists have found a suitable dissolvable stent for this purpose.
Detailed image
They started scientific research two years ago and the stent is now being tested in practice. They are using an advanced new camera that provides a highly detailed image of the artery from the inside, making it possible to place the dissolvable stent even more accurately. Not everyone is automatically eligible for the dissolvable stent. The narrowing must be suitable, without too much calcification in the artery, and the treatment must not be urgent.
Each patient is carefully assessed to determine whether participation in the study is appropriate. The difference between a metal stent and a dissolvable stent is then clearly explained so that the patient can make an informed decision about whether or not to participate in the scientific study.
Day admission The dissolvable stent is placed during a day admission. Patients are then monitored for three years with additional appointments. Cheng explains that this is precisely the period during which the stent dissolves and is absorbed by the vessel wall. According to him, this is enough time to resolve the problems with the arteries and to properly assess how the stent works within the body. ASZ has announced that the results of this scientific study may lead to an even larger follow-up study, which will require collaboration with several Dutch hospitals.
Last April, we wrote about a tool for the deployment and assessment of coronary stents: the AI tool DeepNeo. This technology, developed by a research team from Helmholtz Munich, the Technical University of Munich (TUM) and the TUM academic hospital, automates the analysis of stents after implantation. DeepNeo significantly reduces the assessment time and supports doctors with results comparable to those of experienced medical experts.
