The frontiers of medicine
What is a stent?

A stent is a piece of wire gauze tubing which can be compressed around a balloon catheter. It is used in medical interventions where there is a narrowing or obstruction in a blood vessel. The balloon catheter is inflated and the stent expands within the blood vessel. This both forces the vessel open where it has been blocked, or partially blocked, and provides it with a rigid structure, allowing the blood to flow.

The most common indication for percutaneous vascular intervention (like stent insertion) is the hardening of the arteries - a disease of the elderly. However, the number of indications is growing. In the case of abdominal aneurysms, which affect around two percent of the male population, the primary success rate of this new technique is 86 percent. Other options for the procedure include stent insertion in the carotid artery. New types of stent are already being developed using laser production technology.

The world's first VIR-stent insertion was carried out on January 30, 1997 at the De Wever Hospital in Heerlen, South Limburg. In today's world, with rapidly aging populations, the technique is of growing importance. In the year 2000, fourteen percent of the Dutch population will be over 65; in Heerlen, the percentage will be eighteen.

The new percutaneous vascular option, which is non-invasive, does not require intensive care and can be carried out under a local anesthetic, is a major technical breakthrough. Leading to a reduction in costs in health service, already under pressure, it allows some people to have their cake and eat it; since it removes the expense of traditional therapies, while providing opportunities for the medical device industry to earn considerable revenues.

On entering the angiography room at De Wever Hospital, you come into a control room where banks of Philips Medical Systems Computers monitor and support the procedures taking place in the treatment area. The displays provide patient data, monitor the administration of medication and allow continuous viewing of the procedure.

The contrast dye is injected and the screen comes to life, restoring the tenuous track of the artery to a virile root-like structure pulsing with life. A bell rings - the computer memory is full. The technician leans forward and overwrites a few files. Through the control room window the specialist can be seen applying pressure to the groin where the catheter was inserted. The slight flow of blood is quickly stanched.

It looks easy. However, the skills acquired by radiologist Henk Odink and his team are the result of practice. Currently they carry out around three procedures a day. Practice makes perfect. From a maximum of 45 minutes, Dr. Odink is down to under five in driving his probe through the vascular system, crossing over from left right to the stent's target. As he says, "You can watch what's happening on the screen, but the screen is two dimensional and the vascular system is 3D."

The system is going multimedia. Friday 2 May, will see an intercontinental on-line demonstration from the Miami Vascular Institute, Florida. On Saturday 3 May, there will be an interactive link-up with Aachen Germany's Klinikum Hospital. This is part of the 2nd International Symposium on Vascular Disease and Interventional Radiology. To be held May 1 through 3, 1997.

Removed from the congestion of the urban center of the Netherlands, South Limburg offers an excellent venue for this type of activity. Close to major academic medical centers in Maastricht, Aachen and Liège, with access to an uncongested interurban infrastructure and high quality of life, Heerlen's De Wever Hospital has attracted top specialists in vascular surgery, like Drs. Rob Welten and Ewald Bollen. Cooperation between them and the radiologists with their lab and technical staff have led to an optimal multidisciplinary approach.

The organization of this international symposium, headed by Dr.Odink was based on the teamwork of 26 volunteers including doctors, technicians and lab staff; pointing to the advantage of the practical orientation at De Wever Hospital. Top foreign experts like Gary Becker and Barry Katzen of Miami, Ulrich Blum of Freiburg and Timothy Chuter of San Francisco will meet up with Jos van Engelshoven and Peter Kitslaar of Maastricht to make this the world's leading forum on Vascular Intervention Radiology.

LIM April/May 1997
__

The purification factor

When clients from abroad call Minntech on the free-phone service to Heerlen, they will be put straight through to a sales representative speaking their own language, just as if they were making a call to a company in their home town. Minntech Heerlen is the spearhead of a fast-moving medical-technology operation which, with four business units, is making its presence felt on the world market and producing revenues to match.

Products and Markets
The company's products are handled by four business units: Hemodialysis, Reprocessing and Sterilants, Cardiosurgery and Water Purification. Making medical hollow fibers and keeping them clean is a core activity. The hemodialysis operation alone generates USD 18.6 million in annual revenues.

Minntech was the first company to receive FDA market clearance on a dialyzer labelled for re-use. They have also decided to phase out ethylene-oxide sterilization in favor of steam for the Primus dialyzer, a safer more natural and environment-friendly technique.
Reprocessing and Sterilant products handle other medical devices introduced into the body, reprocessing endoscopes automatically in a market where 60 percent of the operations are manual.

Reprocessing dialyzers is yielding 59 percent sales growth and automatic PTCA catheter testing, sterilizing and packaging remove the potential of human error. The annual global market for catheters is 1.2 million and in Europe only 30 percent are currently being reprocessed.

In cardiosurgery, the company's new Biocor™ 200 is making waves. Less than half the size of first generation oxygenators, it maintains maximum performance and efficiency.
Minntech's water-purification division, Fibercor, doubled its money in 1995 with product sales of one million. The division has expanded its water-purification line with a complete line of filtration products providing the convenience of a single-source supply and the reliability of an integrated system.

Advance planning
Minntech is intending to establish a research operation in Limburg and will be operating closely with the universities and hospitals in the area. ISO 9000 certification means that the company's products will be eligible for the European Community's CE mark, allowing accelerated entry to the world's markets when compared with the pace generally adopted by the FDA in the US.

Direct contact with clients in their own language, expanding markets and a range of state-of-the-art products are being reflected in Minntech Heerlen's revenues. They have doubled their revenues each year since setting up in 1993/94. This also reflects the company's change from sales through distributors to direct sales. At the end of the current year the workforce is expected to double and the company will be looking for space to expand. They will start manufacture of the cathetron machine in Heerlen and probably also dialysis concentrates and chemical sterilants.

The company is fortunate in having a hands-on international executive to guide the operation. MD Andrew Cambell graduated in mathematics in Britain, started work as a dialysis technician and worked his way up through marketing and sales in international companies, both in Europe and the US, to his current position as head of European operations. A man with his background knows why Heerlen is sometimes to be preferred to a beach in Florida, his last US posting.

LIM April/May 1996
__