Thesynergyonline Health Bureau

NEW DELHI, AUG 26 :
RESTENOSIS prevention continues to be a challenge in interventional cardiology. Restenosis - the re-narrowing of a coronary artery - occurs within 3 - 6 months in 40 - 50% of patients, who have angioplasty. This incidence reduced to 20 - 30% with the use of traditional stents. However, restenosis continues to be a problem.

Mr. Uday Kumar (name changed), aged 65 years, had drug eluting stent placed some 2 years back but faced with similar challenges again 3 months ago, after seeing the narrowing within the stent, or instent restenosis, he had no choice but to undergo another treatment or Angioplasty. It was thought, putting another stent was not the best solution.Hence, the patient agreed with the doctor's advice of using drug eluting balloon. SeQuent Please from B Braun with matrix technology, has undergone extensive clinical research, was used after cutting balloon angioplasty. Now, the final result looks very good. The patient continues to do well after 3 months time.

Another patient, Mr. Dheeraj Gupta (name changed), who is 62 years old now underwent Angioplasty few years back with long diffuse disease, came back with the same symptoms some 6 months back. It was observed that his previously deployed stent was completely blocked. Since, the choice was only surgery the patient requested for Angioplasty, with the mindset that if it fails he would not mind! Surgery for him was the last resort.

This patient was also taken for an Angioplasty and the stent was opened sequentially using several devices like cutting balloons, ordinary balloons and rotablator. In the end, drug eluting device SeQuent Please was used to deliver the drug all along the stent. However, it showed recoil at two points and these points were treated with bare metal stent like Coroflex Blue. This procedure in which a drug eluting device SeQuent Please was used followed by a bare metal stent can convert bare metal stent into a drug eluting stent. This patient is also doing well now.

Dr. Upendra Kaul, Executive Director & Dean Cardiology, Fortis Escorts Hospital said, "In-stent restenosis remains a challenge, despite the availability of drug-eluting stents. Approximately, 25 percent of patients treated with a bare-metal stent and about 10 percent of patients treated with a drug-eluting stent develop an overgrowth of vascular tissue and renarrowing inside the stent, or in-stent restenosis."

"Indian population shows a genetic disposition to cardiac blockages due to plaque formation. Approximately 1,50,000 coronary artery disease patients are intervened by cardiologists, out of which approximately 25-30 per cent show instent restenosis specially in small vessel disease, bifurcation lesions and diabetics" noted Dr. Upendra Kaul.

Treating in-stent restenosis with a drug-eluting stent is a complex procedure that adds another layer of metal to the artery and can create mechanical problems. Dr. Upendra Kaul further said, "An angioplasty balloon like device coated with a drug that reduces renarrowing of the coronary arteries appears to be more effective than a drug-eluting stent in treating an unwanted build-up of tissue inside a bare-metal coronary stent.

SeQuent Please drug eluting device technology has been very successfully used to treat such instances in large number of patients. The result seems to be better than putting another drug eluting stent. The polymer less factor of 'SeQuent Please' benefits the patient with fewer side effects. Also, it reduces the need of administering clopidogrel which is an oral anti platelet agent to inhibit blood clots in coronary artery disease. As a result the technology becomes cost effective for the patient."

The drug -eluting device may offer a simpler alternative. This drug-eluting device is coated with paclitaxel. The balloon is inflated for about 30 seconds inside the narrowed artery, and the paclitaxel which has a natural attraction to cells- quickly moves from the surface of the balloon into the arterial cells. Not only does the drug-eluting balloon avoid a second layer of metal inside the artery, the carrier that is used to bind paclitaxel to the balloon is iopromide, a commonly used contrast agent. This avoids concerns about the artery's reaction to the polymers used to bind paclitaxel and other anti-restenosis medications to drug-eluting stents.

Dr. Upendra Kaul said "This drug-eluting device clearly qualifies for consideration as an alternative to drug-eluting stents for the treatment of restenosis inside bare-metal stents. "Not all Balloons are equal" the race today is to make the Paclitaxel available at the site of action as Paclitaxel is 10000 times more lipophilic than other Olimus drugs available and in few studies have been proven to more effective in diabetics. Diabetes is worldwide epidemic and the number projected to be will be 79 million by 2030. A combination of Iopromide + Paclitaxel in the form Matrix is backed by clinical data and is device of choice.".

'SeQuent Please' is an original polymer less drug eluting balloon technology for treating patients suffering from coronary artery diseases. Being polymer less, it has no risk of inflammatory reactions or late stent thrombosis. It provides uniform drug delivery at the target site for faster healing and respects normal contours of the vessel without stent. (editor@thesynergyonline.com)

Thesynergyonline Health Bureau

NEW DELHI, UG 03 :
SC today signed an agreement with Religare Health Insurance Company (Religare) to provide its GROUP/Asia system for Religare’s health insurance operation. CSC will provide Religare a platform to quickly ramp up operations, acquire new business and process high-volumes of health insurance transactions.

CSC’s GROUP/Asia , an established and comprehensive health insurance and managed care system that mirrors the needs of the global healthcare insurance industry is an integrated, flexible solution that allows fast reaction to market demands. The system manages both annual indemnity and health saving products with an emphasis on managed healthcare and group pension.

CSC’s , India's major delivery center will support the implementation of GROUP/Asia at Religare, providing the highest process standards, a skilled workforce, and a focus on mission critical delivery. CSC has helped hundreds of companies map out business and IT objectives, manage costs and risks, and deliver new initiatives as promised.

“We chose CSC as our partner after a thorough and rigorous evaluation,” said Anuj Gulati, CEO, Religare Health Insurance. “GROUP/Asia is a proven, robust product, and CSC’s focus on delivery excellence with highly experienced consultants and a demonstrated approach to long-term partnership were some of the reasons why we chose them. We look forward to working with CSC.”

“CSC is committed to making our clients successful,” said Douglas W. Benfield, vice president of CSC’s Financial Services Group in Asia. “We have a track record for designing and implementing mission-critical systems that have delivered lasting impact to our clients’ businesses. Our innovative solutions and domain expertise have set us apart, allowing us to provide tremendous value to our clients and ensuring their success in the marketplace. We are delighted with this new partnership and committed to Religare's success.”

“CSC’s insurance-focused resources and leading-edge business solutions have helped our clients reach their goals and witness business results,” said Brian J. Manning, president and managing director of CSC in India. “GROUP/Asia is a sophisticated, robust and proven system and we look forward to expanding our relationship with Religare by focusing on providing value.”  (editor@thesynergyonline.com)