Coronary artery disease treatment alternatives, technology trends

 

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In developed countries, cardiovascular disease remains a leading cause of death. Worldwide, cardiovascular disease is responsible for approximately 30% of all deaths; in the United States, the rate is 35%. Cardiovascular disease includes high blood pressure, coronary heart disease, heart failure, stroke, and congenital cardiovascular defects.

Because of the invasive nature of cardiac surgery, medical therapy will always be the preferred treatment protocol favored by many clinicians. To that end, researchers and pharmaceutical manufacturers continue to explore methods of treating atherosclerosis that will render surgery unnecessary.

For instance, researchers at the Medical University of Graz in Austria announced in February 2009 (Journal of Lipid Research, 50:312–326) progress related to their study of a synthetic atherosclerosis drug that can reduce the build-up of plaque without producing the side effect of fatty liver disease, which can lead to other disorders such as diabetes.

However, in some instances, more aggressive therapy is required and for those patients, there is a host of therapy choices available—all of which can prove to be competitive with stenting technology.
 

Alternative therapies for treatment of coronary atherosclerosis include:

  • Angioplasty with or without stenting
  • Atherectomy
  • Coronary artery bypasss graft (open, off-pump/OPCAB, minimally invasive direct/MIDCAB, robotic assisted/RACAB, other)
  • Transmyocardial laser revascularization (TMR)
  • Genetic therapies
  • HDL therapy
  • Drug-eluting balloons
  • Nanoparticles and other agents

Currently, a dominant share of coronary artery disease treatment caseload resides in the angioplasty with stenting option, due to its minimal invasiveness and cost effectiveness (including long term outcomes) compared to alternatives.  However, given the size of the market for treatments of coronary artery disease, it is expected that technology development and trends in clinical practice will continue on all fronts for years to come toward increasingly low-cost, low-invasive, optimal end-points.


Data and analysis drawn from May 2009 report #C245, "Worldwide Drug-Eluting, Bare Metal and Other Coronary Stents, 2008-2017."

 

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