Yao Commentary — Claire Altschuler

Editorial Consultant's Corner

James S.T. Yao, MD

In this issue, we bring you important information on new technology relating to the treatment of cardiovascular disease.

First, Dr. Keith Horvath, a leader in research on transmural laser revascularization, provides an update on this innovative technology.

Second, we present information on new preventive measures for restenosis following coronary stent placement. These include the use of radiotherapy and antiproliferative drug-coated stents. Recent reports on these two techniques have demonstrated promising results for them both. The multi-center trial on Rapamycin-coated stents, under the direction of Charles Davidson, should provide a definitive outcome in the future. If Rapamycin-coated stents are of value in coronary applications, we foresee this technique will be applied to stents for carotid and femoral artery stenosis. Stent placement in carotid stenosis is now in a developmental stage and further refinement of a cerebral protetion device at the time of stent placement will emerge as an alternate procedure to the standard carotid endarterectomy.

Third, Jon Matsumura reports on the placement of vena cava filters at the bedside. Bedside placement technique using intravascular ultrasound guidance greatly facilitates this vital procedure to prevent pulmonary embolism in patents confined to ICU. The technique is cost-effective and avoids potential mishap during transportation to the operating room or radiology suite.

Technology will continue to evolve for better treatment of cardiovascular disease. One area we need to watch closely is biotechnology. Recent reports on the use of stem cells in myocardial infarction have generated great interest. An article in the April 7, 2001 issue of Lancet entitled, Stem Cells Get to the Heart of the Matter provides an insisght into the potential of stem cells to grow new muscle and blood vessels in heart tissue that has been damaged after myocardial infarction. Other investigators have reported the use of autologous skeletal myoblast transplantation in treatment of heart failure. While these techniques remain in the experimental stage, cell biology technology will offer new therapeutic approaches in the treatment of cardiovascular disease.