photo by maria deforrest
â€‹Peter Rosen (left), director of cardiology services at Nanticoke Memorial, and Dr. Ivan Pena, interventional cardiologist.
It’s a simple equation: Cholesterol from food accumulates as plaque in the arteries, creating a narrowing or blockage that forces the heart to work extra hard to pump blood. That plaque often hardens, or calcifies. Sometimes, the heart must work so hard it fails. Blockages are treated in several ways. In some cases, surgeons insert a balloon into the artery, via a catheter, which is inflated to expand the area. After the balloon is removed, a stent, or wire-mesh tube, is placed into the artery to prevent it from closing again.
The process is known as angioplasty. In very bad cases, blockages are surgically bypassed; surgeons remove the section of affected artery, then replace it with a piece of clear artery harvested from another part of the body. Now, there’s another option. Last spring, Nanticoke Memorial Hospital became one of the first hospitals in the country to perform a coronary orbital atherectomy. Using a catheter inserted through the femoral artery, interventional cardiologist Ivan Pena guided the Diamondback 360 Coronary Orbital Atherectomy System into the patient’s calcified areas. The system employs a small diamond burr, spinning at high speed, to sand away calcifications without damaging the soft interior walls of the artery. The calcification is turned into microscopic particles that the body flushes naturally from the system. Coronary atherectomy has been used for many years, most often to clear the large arteries of the legs, says Peter Rosen, director of cardiology services at Nanticoke. Diamondback 360 is a smaller, more refined version of previous atherectomy devices.
In late 2013, the manufacturer, Cardiovascular Systems Inc., received approval from the U.S. Food and Drug Administration to market the device as a treatment for the worst cases of calcified coronary arteries. “You don’t do this procedure unless you absolutely have to,” Rosen says. Orbital coronary atherectomy is also used in patients with peripheral artery disease. Most candidates are 65 or older, diabetic or have kidney disease. Rosen describes candidates as a “subset of a subset” of people with cardiovascular disease. The first Nanticoke patient, a 67-year-old Seaford man, was a prime candidate for the procedure. Having undergone two open-heart surgeries, the insertion of several cardiac stents, surgery on his carotid artery and angioplasty in his legs, he was running out of treatments for new arterial blockages, Rosen says. With blood flow increased to the heart immediately by the surgery, the patient told his doctors the pressure he had been feeling in his chest subsided immediately. The procedure will not allow him to live longer, Rosen says, but it will help him live more comfortably.
Patients must still eat right and exercise. In using the procedure, Nanticoke is in elite company. Based on Nanticoke’s experience with orbital atherectomies in the lower extremities and the quality of its cardiologists, Cardiovascular Systems chose the hospital to be among the first to use the Diamondback 360. Nanticoke thus joins prestigious hospitals such as Boston General Hospital, Cleveland Clinic, NYU Langone Medical Center and Mount Sinai Hospital as pioneers. “That says a lot for our program,” Rosen says. In the first five months after the initial atherectomy, Nanticoke has performed the procedure on a dozen other patients, Rosen says. He expects that pace to remain the norm for the foreseeable future.