Twentieth birthday for life-saving stent medicine

GIVEN that the concept of inserting stents into heart patients in Ireland is 20 years old recently, it would probably be remiss of me not to add my tuppence worth to the celebrations – as someone who has been kept going by three of them inserted almost seven years ago.

 Stents are those tiny wire cages – they’re usually made of titanium and look like a miniaturised and very sophisticated metal tube – which are inserted into diseased arteries which have narrowed and become blocked. The idea is to restore the blood flow to the heart . . . lack of blood flow and resultant starvation of oxygen to the heart muscle is the cause of heart attack.

Thousands of people in Galway are involved in the manufacture of stents – the mega companies working in the stents area and stent research in the city would be Medtronic and Boston Scientific – and it is to one of the products of the latter that I owe the fact that I am still bashing away on the laptop . . . though they warned me that working all hours on the same damn keyboard was one of the causes of my heart attack(s) the guts of seven years ago.

I’m afraid there was no drama like you see on Casualty or Holby City of someone keeling over and being rushed to hospital. In my case it boiled down to not feeling very well, being a little sweaty, a bit like having the Swine Flu without the sore throat and runny nose.

A few days in bed, blood pressure normal, and thought I was not ready to go back to work, I was going back anyway. There had been a suggestion that I might go into that excellent Pain Clinic they have in University Hospital Galway, but I had pooh-poohed the idea.

“I don’t have a bloody pain,” being the logical, if slightly impatient, reply.

However, my better half had persisted and, on the way to work, I turned into the hospital. Here I have to say that the professionalism was extraordinary, a lot of it thanks to the remarkable contribution which Croí (The West of Ireland Cardiology Foundation) has made to equipment, staffing, services and rehabilitation of heart patients.

In 10 minutes I had a diagnosis of heart attack. Not just that, two heart attacks . . . one about two days previously, and the other during the previous night.

Later someone explained it rather unkindly (and somewhat non-politically correctly!) as ‘a woman’s heart attack’ – you have no pain, few symptoms, you get up and dance at a son’s or daughter’s wedding, and then sit down and die in the chair. I was a walking timebomb waiting to go off.

Up to a few years previous to that, the only real choice of treatment would have been a bypass operation in the Mater Hospital in Dublin. But the marvels of ‘stenting’ had by then really taken hold, having started in Ireland in 1989. I was a suitable case for ‘stenting’ and within two hours had the stents inserted at the narrowed points in the coronary arteries, and had my bum back in a bed in coronary care, perhaps the luckiest man in Galway.

The stents were inserted through a cut in the femoral artery in my groin, guided to the correct points by x-ray and a tiny tube (catheter) on which was a balloon which was inflated at the correct point and caused the stent to pop open and prop the arteries open.

In my case there is some debate as to whether the Taxus Stent made by Boston Scientific was the first of its type inserted in Ireland, or possibly in Europe. You see those clever people in Boston Scientific had moved on to a new generation of stent which was impregnated with a drug which made its way into the bloodstream over a period of time.

The beauty of this ‘self-eluting drug’ system is that it delivers a precise amount of drug at the precise point where it is needed to stop the stent becoming ‘gummed-up’ by fatty deposits or plaque (a process known as re-stenosis). It also cuts down on the need for taking other drugs to reduce the possibility of re-stenosis.

In a matter of weeks I fell into the hands of yet another service which has been aided by Croí – in this case the marvellous Cardiac Rehab, which is aimed at getting cardiac patients really back on their feet again, making them immensely fitter, ensuring a better diet, making them capable of walking past choccy bikkies, creamy cakes, burgers and chips, and whatever you’re having yourself sir!

Equally importantly, it is aimed at getting inside the heads of heart attack victims and convincing them that life is not over, that they don’t have to take to the armchair, hotwater bottle and dressing-gown as a way of living, though they do have to develop serious ‘cop on’ about changes in lifestyle.

Interesting that quite recently a new service was launched aimed at stopping people getting to the point where they end up in coronary care – Croí are taking people with significant risk factors that would include issues like high blood pressure, high cholesterol, diabetes, and intervening in their lives long before they have a possible heart attack, or are a candidate for one.

They call this MyAction and the idea is that you take responsibility for your own life and action on it like not smoking, tackling fitness, controlling blood pressure, regulating diabetes, regulating diet, cutting down salt intake and all the other factors which just about everyone knows about . . . but not too many tackle in any sort of concentrated way.

Word on the grapevine is that the MyAction intervention has already made a very significant impact on the lives and long-term health of a number of people.

So, I’m not quite sure if it’s my 67th birthday I’m celebrating at the moment . . . or the 20th of the remarkable stent technology which has transformed medicine and the lives of patients. And let’s not forget, that stent technology is also used in other branches of medicine like cancer and other treatments.

Take a bow Medtronic and Boston.