Category Archives: cardiologists

Cardiac Caths Performed Through the Wrist

TRI Access 3

Each year, more than one million cardiac catheterizations are performed in the United States and more than 90 percent go through the groin to gain access to the arteries that lead to the heart (transfemoral access). However, cardiologists at the Cardiovascular Institute are increasing the number of procedures performed through the wrist (or transradial access). Why? This access approach is improving patient comfort and recovery times.
“Once the artery is engaged,” says Samir Patel, M.D., interventional cardiologist, “whether through the wrist or the groin, the diagnostic and interventional procedures are virtually the same.” One big difference, however, is what happens at the end of each procedure. With transfemoral access, the patient must have pressure applied to the puncture site and lie flat for several hours post procedure under the observation of a nurse or technician. This is necessary to ensure the transfemoral access site reaches hemostasis (no further bleeding). “With transradial access, a wrist band applies pressure to the access site following the procedure, which enables patients to be mobile much faster and have less soreness during recovery,” says Dr. Patel. “Patients are able to get up almost immediately after the procedure, they can use the bathroom, sit up and read a newspaper, eat or have a cup of coffee.”
“While the transfemoral approach is more common,” says Amir Haghighat, M.D., interventional cardiologist, “the entry point is sometimes difficult to access, especially in heavier patients and sometimes in women. In these cases, using transradial access to perform the procedure can reduce the risk of excess bleeding. However, for more complex cases, gaining access through the femoral artery, a larger vessel, remains the standard.”
The increased use of transradial access is not only helping patients to regain mobility faster following the procedure, but in select cases, patients are able go home the same day rather than stay overnight in the hospital. “Our group is excited to work with Bay Medical to gradually increase usage of this access method for cardiac caths,” says Dr. Haghighat. “Working together with the hospital, we are continually improving the quality of heart care available to patients in our community.”

High Risk Patients Successfully Treated with the IMPELLA LVAD at the CardioVascular Institute of Northwest Florida

Interventional cardiologists at the CardioVascular Institute of Northwest Florida have a new tool in their fight against coronary artery disease and heart attacks.  The AbioMed’s IMPELLA 2.5 Liter Left Ventricular Assist Device (LVAD), also touted as the “world’s smallest heart pump”, has been successfully used by interventional cardiologists at the CardioVascular Institute of Northwest Florida since March 2011.  The patients considered needful of this device were those with severe, non-operable coronary disease.  Indeed, some patients were suffering from massive heart attacks.

 

The IMPELLA heart pump is a new minimally invasive treatment option for the most serious of cardiac patients who are deemed too high-risk for surgery.  The IMPELLA is inserted through a small incision in the groin and advanced into the main pumping chamber of the heart, the left ventricle.  Once placed, the heart pump essentially “takes over” the pumping function of the heart, allowing cardiologists to perform high-risk angioplasty procedures for non-operable coronary disease while reducing the risk of heart attack or death during the procedure.  After the procedure is successfully completed, the heart pump is removed with minimal recovery time.  Since the IMPELLA allows the heart to rest and recover by actively taking over the work load of the heart’s main pumping chamber, patients in cardiogenic and advanced heart failure may also benefit from the IMPELLA heart pump.

 

With the support of Bay Medial Center/Sacred Heart Health Systems, the CardioVascular Insitute of Northwest Florida was instrumental in bringing this new technology to Bay County and the Florida Panhandle.  Prior to the use of the IMPELLA heart pump, patients with severe coronary disease or massive heart attacks who were not candidates for traditional coronary bypass surgery would be faced with extremely high risk of complications or death.  The IMPELLA heart pump is one more option in our treatment of the “sickest of the sick” cardiac patients.  The CardioVascular Insitute of Northwest Florida strives to remain in the forefront of the constantly evolving medical landscape to provide its patients the most progressive cardiac care and the widest selection of treatment options.

Cardiovascular Institute of Northwest Florida chosen to participate in the RIVER-PCI Clinical Research Trial

The CardioVascular Insitute of Northwest Florida has been chosen to participate in the international RIVER-PCI clinical trial.  The RIVER-PCI trial is a Phase 3, randomized study of the effects of Ranolzine (Ranexa®) on major adverse cardiovascular events in patients with a history of chronic angina who undergo coronary intervention with evidence of incomplete revascularization.  The CardioVascular Institute of Northwest Florida is one of only two sites selected from the Panhandle and has been enrolling eligible patients since April 2012.

 

Despite the widespread use of coronary stents and medical therapy for coronary artery disease, the incidence of chest pain (angina) after coronary intervention remains high, thus leading to repeat procedures and hospitalizations.  The primary objective of the RIVER-PCI clinical trial is to determine the effectiveness of Ranolazine when used as part of standard medical therapy in patients with chronic angina who have evidence of “incomplete revascularization”, or blockages not yet severe enough to undergo coronary stenting or surgical bypass.  The RIVER-PCI clinical trial will randomize approximately 2600 patients across the United States, Canada, Europe and Israel.  Currently, stents are only approved to treat blockages greater than 70%.  However, patients with blockages less than 70% are still at risk for recurrent chest pain or heart attacks.  The goal of the study is to determine whether Ranolazine will decrease this risk and decrease the need for repeat procedures and hospitalizations.  Patients randomized to Ranolazine will be provided the medication, and all patients that elect to participate in this study will be provided clinical follow-up.

 

The cardiologists at the CardioVascular Insitute of Northwest Florida have demonstrated a strong commitment to clinical research and strive to provide the most progressive, cutting-edge therapy and widest selections of options for their patients.  They have quickly become one of the major enrollment institutions in the world for the RIVER-PCI study.

 

Clinical Research at the CardioVascular Institute of Northwest Florida is coordinated by Linda Deneen, RN, BSN, who serves as the Clinical Research Coordinator.  Ms. Deneen has managed several clinical trials during her seven-year career as a Clinical Research Coordinator.  She also plays an integral role in our local Institutional Review Board (IRB) which overseas all clinical trials performed within Bay County.  Linda previously served as the Research Coordinator at Bay Medical Center/Sacred Heart Health Systems.  She has proven to be a tremendous asset and supervises all the clinical research trials currently underway at the CardioVascular Institute of Northwest Florida.

 

Carotid Artery Stenosis Treatment Options

Carotid artery stenosis is a significant cause of stroke.  Stroke affects at least 731,000 people in the United States alone, and as many as 50% of strokes may be caused by carotid artery stenosis.  The treatment of carotid artery stenosis is either medical, surgical (carotid endarterectomy) or carotid artery stenting.

Conservative medical therapy

Conservative medical therapy for carotid artery stenosis with lifestyle modifications and pharmacotherapy are recommended as a conservative form of treatment.  Hypertension, smoking, diabetes mellitus and hyperlipidemia should be treated in all patients with these risk factors for stroke.  Antiplatelet agents (aspirin, Plavix or Prasugrel) are also of proven benefit in patients with carotid artery stenosis.  Revascularization of carotid arteries (carotid endarterectomy and carotid artery stenting) are treatment options that should be considered in addition to medical therapy alone.

Carotid artery endarterectomy

Carotid artery endarterectomy is the surgical procedure in which a vascular surgeon surgically opens the carotid artery and removes the plaque from the artery to reduce the risk of future strokes.  The procedure has been proven successful in randomized controlled clinical trials in symptomatic patients with a carotid artery stenosis of greater than 50% (NASCET Trial) or in asymptomatic patients with stenoses greater than 60% (ACAS Trial).  Studies have shown that qualified, skilled and well trained vascular surgeons with a proven track record in performing carotid artery endarterecomies have good outcomes with decreased risk of future strokes in their patients.

Carotid artery stenting

Carotid artery stenting is an effective alternative to carotid artery endarterectomy as demonstrated in randomized controlled clinical trials (SAPPHIRE and CREST Trials).  In carotid artery stenting, an embolic protection device is placed across the carotid artery stenosis.  The embolic protection device reduces embolization of debris during the carotid artery stent deployment.  The carotid artery stent is placed via the embolization device which serves as a tracking mechanism for the carotid artery stent placement.  Once the stent is deployed, the embolization device is removed leaving the deployed stent to improve carotid flow, stabilize and trap plaque.  It should be emphasized that Panama City, FL cardiologists that deploy carotid artery stents must be well qualified, skilled and demonstrate a proven track record in carotid artery stenting as do vascular surgeons in carotid artery endarterectomy procedures.

Therefore, the treatment of patients with carotid artery stenosis can be one of conservative medical management only or one of the invasive carotid artery revascularization methods of carotid artery endarterectomy or carotid artery stenting.  Both methods have been clinically tested in randomized controlled clinical trials and by successful significant registry and clinical data of patient outcomes.  Hence, evidence-based medicine is used by the clinician to select the best treatment option based on the patient’s presentation and co-morbidities.  Carotid artery endarterectomy performed by vascular surgeons with proven track records is the surgical option.  Whereas carotid artery stenting when performed by cardiologists with proven track records should be considered in patients who have co-morbidities or anatomical findings that render carotid artery stenting a better option.  Conservative medical therapy should be reserved for patients who have an occluded carotid artery which is not believed to be optimal for either invasive procedure.

The Cardiovascular Institute of Northwest Florida in Panama City  is a participant in the CHOICE Trial Registry.  The patients are neurologically assessed by an independently qualified professional before the carotid artery stent is deployed, the day after stent deployment and 30 days after deployment.  Presently over 60 patients enrolled by the Cardiovascular Institute of Northwest Florida have had no TIA’s or strokes.  The FDA approved carotid artery stenting for patients at high risk for carotid artery endarterectomy in 2004, but the CMS which reimburses carotid artery stenting allowed payment only for those patients who were also symptomatic.  Although the FDA recently approved carotid artery stenting for asymptomatic high risk patients, CMS has not approved carotid artery stenting unless the patients are symptomatic.  However, if the patients are asymptomatic, carotid artery stenting is available only by physicians and hospitals who are participants in highly scrutinized study or registry such as the CHOICE Registry.  Fortunately patients in this area are allowed access to this beneficial technology.