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THE SATURDAY EVENING POST

July/August 2005

THE HEART OF THE MATTER

C A R D I O V A S C U L A R N E W S A T

G L A N C E
to test whether drug-eluting stents, which have demonstrated positive benefits in treating patients with coronary artery disease (CAD), could offer similar benefits in treating arteries outside the heart. The stent is a small metal device that acts like a scaffold to help prop open blocked arteries. All too often, however, arteries become blocked again as scar tissue forms around the implanted stent. To prevent return of blockage, the stent is coated with paclitaxel to potentially reduce the risk of renarrowing of the artery.

FATAL IMPACT: W H E N SECONDS COUNT

It can happen in VQ^ of a second. A fastball, lacrosse shot, or wayward elbow to the chest can be deadly. While injuries on the field and in the athletic arena are common, no one anticipates that a young athlete will die of a mysterious but all-too-common syndrome called commotio cordis. a rare disruption of the heart's electrical system resulting from a blunt impact to tbe chest that leads to cardiac arrest. The syndrome is a poorly recognized and underreported event that happens to healthy young athletes as a result of a low-energy, nonpenetrating blow to the chest. Commotio cordis does not result solely from the force of a blow. It is largely the result of the exquisite timing of the blow during a narrow window within the repolarization phase of the cardiac cycle. 15 to 30 milliseconds prior to the peak of what Is called the heart's T-wave. Young athletes, such as 14-year-old LOUIS ACOMPORA Louis Acompora, who died while playing lacrosse for his high school, are especially at risk because of the pliability of their chest walls. Time is a critical factor after the onset of the event. Early defibrillation is essential. To prevent deatbs from commotio cordis. it is necessary to train coaches, bystanders and other sports personnel in the recognition of this event. Access to automated external defibrillators (AEDs) within minutes is crucial to achieve this goal. Equipping schools with AEDs is central to the mission of Neighborhood Heart Watch, which is spearheading the Keep the Beat campaign with AED maker

"We already know the benefits of drug-coated stents for the treatment of coronary artery disease." said Michael Dake. M.D.. the principal investigator of the multicenter study. "We're hoping to translate that success to the peripheral circulation, especially in the legs, where blockMedtronic, to save lives with early ages can be disabling." defibrlllation. To learn more. log on to www.neighborhood-heart-watch.org. Researchers plan to enroll 60 patients in the pilot study, which is PROMISING T R E A T M E N T being conducted in 10 U.S. medical F O R BLOCKED LEG facilities. Recruitment is expected to ARTERIES be complete by the end of 2005: an expanded trial is planned pending In March, a landmark clinical trial FDA review of initial results. evaluating a drug-coated stent for peripheral arterial disease The stent was (PAD) received itsfirstpamade by Cook. Inc.. a tient. TTie disease, which large medical-device affects more than 10 milmanufacturer that is lion Americans each year. sponsoring the clinioften goes undiagnosed. cal trial. according to the AmeriEligible participants can Heart Association. who have crampy calf PAD affects blood vespain after walking, sels that lead from the relieved by rest, will heart to other areas of be tested to see if they Researchers hope a drugthe body, such as the have a blockage in coated stent to prop open legs. feet, and kidneys. clogged leg arteries will help the superficial femoral When blood vessels bearteiythe most compatients avoid amputation. come blocked due to fatty mon cause of such deposit buildup, blood circulation bepain and tbe target of this clinical comes restricted. Untreated. PAD can trial. Those interested in participating lead to pain when walking and potencan learn more about enrollment by tial gangrene and amputation. contacting the research coordinators of Stanford's Division of InterventionThe trial at Stanford University al Radiology at 650-725-9810. Medical Center is the first in the U.S.

Is your local sdiool equipped with an AED? An errant lacrosse shot, faslball or elbow lo the chest at a critical millisecond in the cardiac cycle could lead to cardiac arrest. Immediate debrillation is essential.

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