New treatment clears clogged arteries

Imagine a treatment for clogged arteries that opens them up much in the same way Drano clears a clogged drain. That is the principle behind a new therapy surgeons are testing and so far it is working.

For years, Joseph Mashtaler spent all his spare time exploring the outdoors near his home in Ontario, Canada. Then two years ago, heart disease kept him virtually housebound.

"Even my children who are adults said, 'Dad, what happened? You were invincible.’” said Mashtaler. “That's what hit me. I just want to be normal. That's all."

The artery leading to Joseph's heart was completely blocked. Doctors tried a traditional approach to reopen the artery, but plaque buildup inside his arteries was too dense for angioplasty to work.

Then Doctor Bradley Strauss at Sunnybrook Health Sciences Centre in Toronto, Canada began pioneering a new treatment that would give patients with total blockage another option.

"I've been working on a type of chemical Drano to soften the plaque, to soften the collagen, inside the plaque so it's easier to cross with our conventional guide-wires and equipment," said Strauss.

Doctors inject an enzyme into the blockage which softens the plaque overnight.

"We'll bring the patient back the next day and will just use a conventional approach to doing angioplasty," said Strauss.

Strauss said that reopening the artery this way could mean some patients may not have to undergo bypass surgery at all.

For Mashtaler, that meant a faster recovery, giving him a reason enough to celebrate.

Strauss was able to successfully perform angioplasty on 12 of the first 15 patients who were injected with the enzyme.

All of the patients in the trial had a previous failed attempt at opening the occlusion.

Strauss is about to begin a large clinical trial of the enzyme in Canada and the United States.

Research Summary:
TOPIC: DRANO FOR CLOGGED ARTERIES

BACKGROUND: Dr. Bradley Strauss, the Chief of the Sunnybrook Schulich Heart Centre and the Reichmann Chair of Cardiovascular Sciences, is conducting a clinical trial on a new treatment for patients with coronary arteries that are completely blocked by plaque. The treatment is the first biological solution ever developed to treat blocked arteries. During the therapy, the enzyme collagenase is injected into a blocked artery to soften the plaque. Once the plaque is softened, a cardiologist can perform traditional angioplasty by sliding a guide-wire through the otherwise impenetrable blockage and inserting a stent to re-open the artery. The end result is a restoration of blood flow. (SOURCE: Facmed.utoronto.ca)

OVERVIEW: The coronary arteries are blood vessels that supply the heart muscle with the blood, oxygen and nutrients it needs to keep functioning. When coronary arteries become narrowed or clogged, blood is not able to reach the heart, which over time, can cause chest pain, shortness of breath, or in some cases, a heart attack. These blood vessels can become blocked with fatty buildup of plaque in a process called atherosclerosis. That plaque, which is comprised of fat, cholesterol, calcium and other substances, narrows the arteries and reduces blood flow. Coronary artery blockage can be treated in many different ways, and according to the Mayo Clinic, treatments may be tailored to the patient, based on the severity of the condition. A variety of different medications are used to treat coronary artery disease. If that doesn't work, physicians may suggest surgery or coronary angioplasty. This new procedure is good for patients who experience symptoms that would be relieved with angioplasty. Coronary angioplasty is not surgery. It opens a clogged coronary artery by inflating a tiny balloon in it. Many people with blocked arteries can benefit from angioplasty. However, in some cases, the blockages are so cemented that it is often impossible to get a guide-wire through them. Past efforts to treat patients with these types of blockages have been focused on designing stronger, more deliberate guide-wires to force through the blockage. However, the success rates for those methods are low. As a result, many patients are not candidates for the procedure and either have to be treated with medication alone or undergo bypass surgery. With this new procedure, scientists are testing to see if collagenase can soften the plaque to allow a cardiologist to perform a successful angioplasty. (SOURCE: Facmed.utoronto.ca)

CLINICAL TRIAL: Dr. Strauss and his team of scientists at Sunnybrook's Schulich Heart Centre are conducting a phase I, first-in-human clinical trial to test the safety and effectiveness of the new procedure. Study participants were selected from a group of Sunnybrook patients who have had at least one failed angioplasty attempt. An independent data safety monitoring board is responsible for reviewing the results and monitoring any adverse effects. The trial results will be used to determine the best dose for a large-scale clinical trial. The clinical trial is funded by the Canadian Institutes of Health Research (CIHR).

FOR MORE INFORMATION, PLEASE CONTACT:
Laurie Legere, Communications Advisor
Sunnybrook Health Sciences Centre
Toronto, Ontario, Canada
(416) 480-6100 ext. 7351
Laurie.Legere@sunnybrook.ca


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