Cardiologists at Rush-Presbyterian-St. Luke's Medical Center in Chicago are currently testing a new miniature-filtering device designed to make angioplasty safer. Rush is among 50 medical centers in the country, and the only medical center in Chicago, testing the device.
The device, called CardioShield from Ireland-based MedNova, catches small particles of debris that can come loose when an angioplasty balloon is inflated to open clogged blood vessels. CardioShield has a filter with holes about 140 microns in diameter and acts much like a net, catching debris while allowing blood to continue flowing during the procedure.
In standard angioplasty, a wire stent and balloon are threaded through the femoral artery in the groin to the area in the chest where the blockage occurs. Once positioned in the clogged artery, the balloon is expanded and spreads the blockage against the artery wall to open the artery. A stent is then put in to prop open the artery. In some cases, the angiogplasty procedure can cause material that comprises the blockage to break loose and float "downstream" to smaller blood vessels, leading to heart attacks and stroke.
This problem is more acute when the angioplasty is done on veins used in bypass surgery that come from the patient's legs because these veins are more prone to complications as they age. A study in the Journal of the American College of Cardiology found that 45 percent of these veins experienced blockage 11 years after the bypass surgery. These veins are also more likely to contain soft obstructive material that may be easily disrupted by procedures like angioplasty.
In a preliminary study of 29 patients with clogged arteries, the CardioShield device collected debris in 67 percent of patients. Such debris, when allowed to float down into smaller blood vessels, can put patients at risk for a heart attack, according to Dr. Jeffrey Snell, director of Interventional Cardiology at Rush. In the Rush study, a CardioShield device is threaded through the blocked artery first and the balloon and stent follow, allowing the filter device to effectively catch any debris that breaks free. Once the blockage is cleared with the balloon angioplasty and stent placement, the CardioShield device is removed and the debris is analyzed to determine the composition of the material.
Snell recently treated the first patient in Chicago with the device and will be using it with others soon. Patients eligible for the study must have had heart by pass surgery in which their saphenous (leg) vein is more than 50 percent blocked.
"Most interventional cardiologists have had patients who have experienced a cardiac event while undergoing angioplasty. This device offers an approach that can prevent those events from happening," Snell said. Just as angioplasty is safer than open-heart surgery in appropriate patients, CardioShield will make angioplasty safer for all patients by protecting them from this complication, he added.
CardioShield is one of a small number of devices being tested by cardiologists at Rush and around the country to ensure angioplasty continues to remain safe. Earlier this year, Rush completed a study of a device called PercuSurge, which also blocks debris from blocked arteries from floating freely through a blood vessel by using a balloon and suction catheter. Snell indicated that Rush will soon embark on a trial comparing the two devices to determine which one is the most safe and effective for patients who need angioplasty. More than 13 million people in the United States have been diagnosed with coronary artery disease, the leading cause of death in this country. This year alone, an estimated 1.8 million patients will undergo procedures such as coronary bypass surgery and balloon angioplasty to reopen their arteries.
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Rush-Presbyterian-St. Luke's Medical Center encompasses the 824-bed Presbyterian-St. Luke's Hospital (including Rush Children's Hospital), the 110-bed Johnson R. Bowman Health Center and Rush University. Rush University, which today has 1,271 students, is home to Rush Medical College, one of the first medical schools in the Midwest. It also includes one of the nation's top-ranked nursing colleges, the Rush College of Nursing, as well as the College of Health Sciences and the Graduate College, which offer graduate programs in allied health and the basic sciences. Rush is noted for bringing together patient care and research to address major health problems, including arthritis and orthopedic disorders, cancer, heart disease, mental illness neurological disorders and diseases associated with aging. The medical center is also the tertiary hub of the Rush System for Health.
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