Dr. Anas Safadi, a cardiologist at St. Mary Medical Center, explains T-CAR, a minimally invasive procedure to clear carotid blockages and reduce stroke risk.
Cardiovascular disease accounts for nearly one-third of all deaths worldwide each year.
To help reduce these stunning numbers, hospitals in the Region are utilizing cutting-edge technology. From minimally invasive surgical procedures to advanced imaging techniques, these state-of-the-art technologies are helping doctors diagnose and treat heart disease with greater precision and effectiveness.
For high-risk patients
Angioplasty has long been a procedure used to open a blocked artery so a stent can be inserted, allowing blood to more freely flow. Yet for some patients, what’s now known as percutaneous coronary intervention can be a risky procedure.
Cardiovascular comorbidities such as heart failure and the severity of a patient’s blockages can affect whether that person is suitable for angioplasty, says Dr. Mihas Kodenchery, a cardiologist with Methodist Physician Group.
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“These high-risk stent procedures are very stressful for the heart,” Kodenchery said. “They are at high risk of the heart stopping, lungs flooding with fluid, blood pressure dropping and the heart flipping into a dangerous rhythm.”
Yet with a tool called Impella, more high-risk patients can take advantage of this life-saving procedure, he says. Impella is a small heart pump that helps maintain blood flow during these procedures.
“When we use Impella, part of the work of the heart is done by Impella during the procedure,” Kodenchery said. “So the patient and the heart tolerate them well, and reduces the risk of complications and improves the outcome.”
The Watchman implant can help people with A-Fib and end the need for lifelong blood thinners, says Dr. Jay Shah, a cardiologist with Northwest Health.
Complete picture within minutes
The increased availability of a coronary CTA is helping doctors get a clearer picture of how significant a blockage is in a patient’s arteries.
Dr. Jay Shah, a cardiologist with Northwest Health, says a coronary computed tomography angiography is a noninvasive procedure that reveals plaque buildup in the coronary arteries.
Studies show that nearly half of all adults have cholesterol buildup without known heart disease or symptoms.
A coronary CTA involves an injection of iodine-containing contrast material and a CT scan to examine the arteries that supply blood to the heart.
“Within minutes we can get a complete picture,” Shah said. “That is significant in seeing the severity of the blockage and helping guide any decision-making with treatment.”
CT scanners have become more sophisticated, Shah says, allowing doctors to more quickly evaluate blood flow to the heart and determine whether a patient has heart disease.
In 2021, the American College of Cardiology (ACC) and American Heart Association (AHA) updated their evidence-based recommendations that address the diagnosis and evaluation of acute and stable chest pain in patients who come to the emergency room. Last year, Northwest Health-Porter announced that it had adopted these new guidelines for cardiac imaging.
One of the most significant updates is the elevated role of a coronary CTA to a Class 1 recommendation, the strongest for a medical test that indicates need for possible treatment or intervention.
The detailed recommendations are the first set of guidelines from the ACC and AHA that address chest pain and offer a roadmap for physicians when evaluating patients with or without known coronary artery disease (CAD), as well as patients who have risk factors such as age or other health conditions.
“Cardiac CTA is becoming the new, quicker way to evaluate blood flow to the heart to determine whether someone has a blockage,” Shah said.
Reducing stroke risk
Blockages in the carotid artery increase risk of a stroke, says Dr. Anas Safadi, a cardiology specialist with Community Healthcare System.
TransCarotid Artery Revascularization, or TCAR, is a revolutionary procedure performed through a small incision in the neck and designed to reduce this serious risk.
The traditional treatment for carotid artery blockages has been an open surgery called carotid endarterectomy. For patients who have more risk factors, such as advanced age or other medical conditions, this procedure is risky.
TCAR offers an alternative. It involves making an incision in the neck, placing a tube into the carotid artery and temporarily reversing blood flow away from the brain. This prevents loose bits of plaque from reaching the brain, which can cause a stroke, Safadi says.
A stent is then inserted into the artery to stabilize the plaque.
“The pressure difference shunts blood away from the brain completely, therefore reducing the risk of a clot or debris going to the brain while the stent is being deployed,” Safadi said.
TCAR can benefit most patients with significant carotid disease and help reduce their risk of suffering a stroke, he says.
“The ideal patient is one who has blockage that is significant, which is more than 50% in patients who have a history of stroke or 70% in those who have never had a stroke,” Safadi said. “The procedure reduces the risk of stroke compared to the old stenting technique and is at least as equivalent to surgery in risk of stroke, with less risk of nerve damage, reduction of surgical time and quicker recovery.”
Most patients go home early the next morning, he said.
“There are even some centers that do the procedure with local and moderate sedation, reducing the risk of anesthesia to patients,” Safadi said.
Another important tool used to reduce stroke risk is the Watchman device, Shah says. This device replaces the long-term use of blood thinning medication in many patients who have atrial fibrillation (A-Fib), a condition that causes the heart’s upper chambers to beat out of coordination with its lower chambers. Those who have been diagnosed with A-Fib carry a higher risk of stroke, Shah said.
The Watchman is implanted in a minimally invasive procedure for people who have atrial fibrillation not caused by a heart valve problem. The device closes off the heart’s left atrial appendage, where most blood pools and forms a clot in A-Fib patients. By keeping blood clots from escaping and traveling to other parts of the body, a stroke can be prevented.
“Some people cannot tolerate blood thinners because of bleeding issues,” Shah said. “But at the same time, we don’t want that higher risk of stroke to be present. We can put a Watchman device in there and lower the risk of stroke and get rid of the need for a blood thinner.”
A quicker return home
An alternative to open heart surgery, TAVR, or transcatheter aortic valve replacement, is a minimally invasive heart procedure that replaces a thickened aortic valve that can’t fully open.
TAVR is another example of an innovative procedure offered in Northwest Indiana that allows patients to spend less time in the hospital.
If the aortic valve, which is between the left ventricle and the aorta, can’t open correctly, blood flow to the heart will be restricted.
For those who may be at risk of complications from open heart surgery to replace a damaged aortic valve, TAVR uses smaller incisions and a catheter to the heart while implanting a valve made from cow or pig heart tissue.
“Now at Northwest Health-Porter, we can replace the valve through the groin and patients go home by lunch the next day,” Shah said.
Dr. Mihas Kodenchery, a cardiologist with Methodist Physician Group, explains how the Impella device can help high-risk patients during heart procedures..
