An Inside Look at Interventional Cardiology

In the Spotlight - Dr. Alan Yeung, MD

Dr. Yeung Interview on Insider Medicine:

What is the problem you are trying to solve?

The problem Iíd like to solve revolves around the issue of blockages in the coronary heart arteries. Particularly for patients that have risk factors such as diabetes, high blood pressure, smoking, and high cholesterol, what happens is that the heart arteries will develop blockages. If these blockages get very severe, the patients will get angina and heart attacks. My research is mainly focused on three parts of this problem. First, how did we develop the problem and can it be stopped in its tracks, meaning can we prevent it from happening in the first place? Second, once developed, how can we treat the problem earlier with technology such as stents and other devices to remove the plaque and make sure it doesnít come back. Third, for patients that have very advanced disease that are not candidates for surgery or the stenting procedures, we are looking at using stem cells to help these patients grow new blood vessels around the blockages and naturally bypass the blockages.

What are the results of your research?

In terms of better understanding how these blockages form I have outlined the traditional factors already. But we have also started looking at some of the genetic markers for those whom we donít know why, at a very young age for example, with normal cholesterol levels and no risk factors, these blockages develop. There are certain genes we are starting to identify that predispose these patients to those conditions. What we are hoping for is that once we can identify them (sometimes it is through a relative of a patient, meaning that the patient is asymptomatic, but their relatives have had heart attacks), that we start to modify the risk factors very aggressively and hopefully can use new medicines that may come up to raise good cholesterol. In the stenting portion of my research we have developed and worked with many different technology companies to better stents which may prevent new scar tissue from forming and also become safer so they will not develop blood clots in the later part of their life. Lastly, we are very excited to have just finished a part of a nation wide study to use the patientís own stem cell injected into the heart muscle to see if they can grow a blood vessel. It looks pretty safe but the results are not in yet whether it is helpful or not. It was a randomized study meaning some patients received the treatment and some received a placebo of either sugar or saline in the heart.

How will your research impact patient care?

If all three components of my research come to fruition or at least produce good expected results I think we will start to be able to tell our patients that they will never have a heart attack. Similar to conquering cancer, this will be like conquering cancer of the heart. With reasonable habits, they will be able to prevent blockages from forming in the heart either through medication or through genetic manipulations of the blood vessel wall. If they unfortunately do get blockages, we can detect early, intervene early, and put in stents or devices that are bio-absorbable that would be there for a little while and then disappear. These would temporize and allow the patient to heal over those areas. And finally, for patients who have had bypasses or stents previously, but those failed, we would be able to use their own cells to build their own new blood vessels completely from their own heart muscle cells, and allow them to have a natural bypass. So, if all three components of the research within the next ten years come to fruition, then essentially patients would not have heart attacks or angina and it would allow them to live a full quality of life until advanced age.

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