Dave Sanford, an 18-year veteran technician in Sacred Heart Medical Centers cardiac catheterization labs, had been waiting to hear about a tool that could help doctors open up a totally blocked coronary artery without conducting open-heart surgery.
Rather than just for Sacred Hearts patients, though, Sanford needed the tool for himself.
The 53-year-old cardiovascular technologist suffered from whats called a chronic total occlusion (CTO) of a coronary artery. That meant his artery was virtually 100 percent blocked by the rock-hard plaque that builds up in the arteries and restricts blood flow from the heart.
While its common for doctors to open up partially blocked coronary arteries using various types of angioplasty and to brace them open with wire stents, CTOs in the past usually couldnt be treated with such minimally invasive techniques, and instead, often were corrected with open-heart surgery.
I just wasnt ready for that, says Sanford, who had known about his CTO condition for about three years and has had six stents placed in other arteries over the past nine years. He received his first stent in 1994, after having suffered a heart attack.
Sanford says he was willing to deal with the occasional chest pain caused by the blockage while waiting for technology to come along that would allow him to avoid bypass surgery.
That technology arrived in Spokane earlier this month, when interventional cardiologists here began using a relatively new device called the Frontrunner to open CTOs sufficiently so that more conventional catheter procedures such as balloons and stents can be used.
Sanford was one of five patients to undergo catheterization at Sacred Heart last week using the device. Dr. Matthew Selmon, a California cardiologist and co-founder of LuMend Inc., the Redwood City, Calif.-based maker of the Frontrunner device, was in Spokane to assist three Spokane cardiologists who performed the procedures, and teach them how to use it.
They were Drs. Don Canaday, David Stagaman, and Angelo Ferraro. Canaday had used the device successfully here earlier in the month.
In Sanfords case, Ferraro ended up not having to use the Frontrunner because once a catheter was in place, he was able to slide a guide wire through the blockage and maneuver a stent into place to open up the artery, something that had been tried unsuccessfully on that artery a couple of years earlier.
Tapping at the blockage with a guide wire is a typical first step before using the Frontrunner. This time it went through.
Ferraro said afterwards that even though the Frontrunner wasnt used on Sanford, the fact that it was available made the procedure performed on Sanford possible.
Thats because, based on the earlier failure, Sanford likely wouldnt have been scheduled for another catheterization without the hope of breaking through the blockage with the device.
Sanfords blocked artery had been written off as undoable, said Ferraro. We wouldnt have tried again without availability of the Frontrunner.
Selmon says the device, which received U.S. Food and Drug Administration approval in February 2002, already has been used on thousands of patients around the U.S. and abroad. Sacred Heart says use of the device likely will become common here.
Like most catheterization tools, the Frontrunner is mounted on the end of a very thin metal wire that is guided up through the femoral artery in a patients groin area all the way to the arteries surrounding the heart.
The cath lab in which such procedures are done is equipped with fluoroscopic imaging equipment that displays images on video monitors that cardiologists watch as they guide the catheter into place and work to clear a blockage.
The Frontrunner tool looks a bit like a tiny set of jaws, and at first blush one would think it is used to chew away at the blockage.
Thats not the case, however. Once guided to the blockage, the blunt-faced Frontrunner is forced gently into the blockage with its jaws closed. Using a lever at the other end of the guide wire, outside the patients body, the cardiologist then opens the devices jaws, pushing the plaque toward the walls of the artery, thus creating a small channel through the blockage.
The action of opening and closing the jaws, and of rotating the Frontrunner to get it into various positions, is repeated many times during the procedure, which is considered highly technical and can take as long as an hour a half.
Through that new channel a cardiologist then can guide a balloon into place to open the artery further and position a stent there to keep the artery open, as would be done with a conventional partial blockage.
As Sanfords stent procedure was being done without the Frontrunner, Stagaman was using the new device in another cath lab at Sacred Heart to try to open a CTO in a 61-year-old man. In that case, plaque had built up along the walls of the artery beyond the blockage, and when Stagaman created a channel through the blockage the channel continued on through the wall-bound plaque behind the blockage, rather than breaking through into the main channel of the artery.
In such cases, says inventor Selmon, the patient likely will be brought back in two or three months for another try, after that false new channel has closed up.
The disruption of the plaque from the procedure this time likely will make the chances of success a second time around better, he says.
Tim Ugaldea, Sacred Hearts director of cardiology, says such procedures usually cost between $10,000 and $12,000, compared with an average balloon angioplasty procedure cost of about $7,000. Still, he says, the cost is far less that than the $20,000 to $25,000 cost of an open-heart coronary bypass surgery, which also is more risky and requires a months-long recovery process.
Like other forms of interventional cardiology, however, use of the Frontrunner should be done in a facility where surgeons can be standing by to open the patients chest if something goes wrong, Sanford says.
Having worked side-by-side with physicians at Sacred Heart for hundreds of cath-lab procedures over the years, he says hes very comfortable undergoing the procedure here.
He says he could have had the procedure earlier in another city where the Frontrunner was being used, but wanted to stay in Spokane, where I know the surgeons and where my family is close by and can stay in their own homes.
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