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Sunday, 13 August 2017

How to prevent and treat coronary in-stent restenosis with Chinese medicine?

Tiejun Tang


Coronary in-stent is the most common treatment in coronary heart disease (CHD).  It can improve myocardial ischemiaand release angina immediately. About 800,000 Americans receive stents each year. Although coronary artery stent is very effective on CHD, but the ischaemic heart disease still is the world’s biggest killer according to WHO’s report (2012). Statistical data showed 73,000 people died from CHD every year in the UK. (200 died per day). The biggest problem in the treatment of CHD is restenosis or re-narrowing of the coronary artery. 

Restenosis usually occurs 6-9 months after stent placement, as a result of neointimal hyperplasia due to the proliferation and migration of vascular smooth muscle cells. A recent research report showed that from 2006 to 2014, 65,443 patients underwent percutaneous coronary intervention (PCI) and 6,872 patients (10.5%) with 8,921 lesions were treated for in-stent restenosis (ISR). The proportion of patients undergoing revascularization for restenosis increased 0.28% per year[1].

The small scaffold stent props open the diseased artery to prevent heart attacks, but because
the body treats stents as foreign, the risk of blood clots is ever present. That is why its short term effects are good, but long term effects are not satisfactory.  Dr Aseem Malhotra said to Daily Mail: ‘There is no evidence that coronary angioplasty reduces risk of heart attack or death in patients with uncomplicated stable angina’

In traditional Chinese medicine (TCM) angina is known as Xin Tong or Xiong Bi. The common pathological mechanisms of this disease were due to heart blood stagnation, heart yang deficiency, cold stagnation or phlegm obstruction. Chinese medicine usually selects different herb formula to treat different individual cases. Some formulas have been used for thousands of years. Every prescription was modified according to the symptoms of the individual patients.

 

In China, Chinese herbal medicines are widely used for preventing restenosis after stent placement. A Meta-analysis on 52 trials (4905 patients),  the result showed at the end of at least 3 months' follow up, Chinese herb medicine could significantly reduce restenosis rate, cardiac mortality, recurrence rate of angina, acute myocardial infarction, numbers of repeat PCI, and numbers of coronary artery bypass graft[2]. Chinese herb treatment includes extracts from mixtures of herbs, single herbs, or a compound of herb decoction.  The most commonly used single herb is Dan Shen (Salvia miltiorrhiza). More than 230 randomized controlled trials (RCTs) of Danshen dripping pillin treating angina pectoris. Among the included 109 RCTs with 11,973 participants, the efficacy of Danshen was better than isosorbide dinitrate in treating angina pectoris[3]. Dan Shen also showed a good effect on preventing restenosis after coronary stent[4].  Xiong Shao capsule is an herbal remedy which was composed by ChuanxiongLigusticum chuanxiongand Chishao (red paeony root). Clinical study showed it can effectively prevent restenosis after PCI in combination with conventional western medical treatment.[5]

If you have time to read all of reference below this article, you will understand coronary stent and by-pass operation are not only option in CHD treatment. TCM as an alternative option is the right choice, because it can reduce the mortality rate and save lives. 

Reference:
1. Waldo SW. Incidence, procedural management, and clinical outcomes of coronary in-stent restenosis: Insights from the National VA CART Program.Catheter Cardiovasc Interv. 2017 Jun 28. doi: 10.1002/ccd.27161. 
2. Zheng GH.Systematic Review of Chinese Herbal Medicines for Preventing in-Stent Coronary Restenosis after Percutaneous Coronary Intervention. Evid Based Complement Alternat Med. 2012;2012:253409.
3. Jia Y. How Efficacious is Danshen (Salvia miltiorrhiza) Dripping Pill in Treating Angina Pectoris? Evidence Assessment for Meta-Analysis of Randomized Controlled Trials. J Altern Complement Med. 2017 Jun 26. doi: 10.1089/acm.2017.0069
4. Fu GS. Clinical observation of compound Danshen drop pill preventing restenosis of patients with coronary heart disease after stenting operation (Part 1) China Medical Herald2009; 6:68–69.
5. Lu XY. Clinical study on effect of Xiong Shao capsule on restenosis after percutaneous coronary intervention. Chinese Journal of Integrated Traditional and Western Medicine. 2006;26(1):13–17.