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Randy Thomson
Acorn Newspapers
Doctors Sanjiv Goel and Vishva Dev of the cardiology department at Los Robles Hospital & Medical Center in Thousand Oaks work with a digital X-ray machine that helps physicians more accurately diagnose potentially fatal heart and arterial problems, as well as perform procedures such as carotid stentings that are far less invasive than conventional surgery.

Carotid Stenting
Breakthrough procedure means fewer surgeries

By Daniel Wolowicz, Thousand Oaks Acorn
October 27, 2005

Inside the cool, stark-white lab at Los Robles Hospital, cardiologists Vishva Dev and Sanjiv Goel stand beside a new digital X-ray machine, a cardiovascular imaging system that the doctors say will become a powerful weapon in the battle against heart disease and stroke.

The $2-million machine, one of two recently purchased by the Thousand Oaks hospital, helps cardiologists better diagnose patients and perform such procedures as balloon angioplasties.

Earlier this month, the state-of-the-art machine allowed Goel to perform a cutting-edge procedure called a carotid stenting. It was one of the first carotid stentings done in Ventura County and could mean that Conejo Valley residents will no longer have to undergo lengthy surgery to clear clogged neck arteries.

What was once a health problem that required major surgery and a lengthy hospital stay may soon be treated with a common, hour-long, out-patient procedure requiring only local anesthesia. Recovery time will be reduced from a week to only 24 hours, according to Dev and Goel.

Peter Amore, an 83-year-old Newbury Park resident, was the first patient to undergo the procedure at Los Robles.

"When I heard they had a new treatment for clogged arteries, I thought it was a great idea," Amore said.

The carotid arteries are located on each side of the neck and originate from the heart. The two arteries supply blood to the brain and are critical. When plaque, which consists of cholesterol and other substances, builds up along the arterial walls, it causes the arteries to narrow. As the arteries narrow and harden, the blood flow to the brain is reduced and a stroke can result.

The condition, known as carotid artery disease, is potentially lethal because a piece of plaque may break off and make its way into the brain.

A number of imaging procedures, including an ultrasound, are used by doctors to identify dangerously clogged arteries.

"Two years ago, I was told my arteries were 65 percent clogged," Amore said. "Just before they did the stenting, they said I was at 90 percent."

The carotid stenting procedure begins with a small puncture over a groin artery. Doctors then insert a small catheter, which they navigate into the carotid artery. Once inside the artery, a small balloon is inflated to open up the artery.

A small, titanium mesh tube (stent) is then used to support the arterial wall and open the clogged section of artery. Before the opening and cleaning of the artery, a filter is inserted farther up the artery to catch any plaque that separates from the arterial wall.

After the stent is placed, the filter and the catheter are retracted. Eventually, the artery heals around the stent, which helps to keep the artery from clogging again.

Patients remain awake throughout the procedure.

"I didnít feel a thing," Amore said. "I had pain when a nurse had to close the wound, but I was able to move around pretty quickly afterward." Amore said he took two Valium before the carotid stenting.

Because the procedure is so new, Guidant Corporation, an Indiana-based company that specializes in cardiovascular medical products, is the only medical supply manufacturer in the United States that makes the catheter.

Goel said the most delicate part of a carotid stenting is setting the filter in place. To do so, doctors must push the catheter past the blocked area without disturbing the plaque on the arterial wall. Goel said it is crucial to get the filter in place before the stenting portion of the procedure begins. "Only very few people can handle that wire," Goel said. "Thatís why a cardiologist who has used that type of instrument during a coronary procedure should be doing (carotid stenting). Not everybody can do this procedure. . . . We have mastered the skills on other procedures that we bring to this procedure."

Dev, whoís also the Los Robles chief of staff, said cardiologists at the hospital have been training to perform a carotid stenting for nearly nine months.

"Every component of the procedure has been trained separately and more than once to make sure that we do it right," Dev said. "We went to four or five different conferences to get all the necessary skills."

Dev said the cardiac staff visited other hospitals to observe the new procedure.

Because recovery time is shorter than regular surgery, more insurance companies are covering the procedure in their medical plans.

"I feel good," Amore said, "probably better than I would if they had to go through (with) the surgery."

Dev said the carotid stenting is the next step in the hospitalís goal to build one of the leading cardiology departments in the nation.

"What they are doing brick-by-brick is laying the foundation for creating a center that has todayís cutting-edge technology (and) patient care," Dev said. "We are able to introduce elements of research that hadnít been here before."

Pre-Procedure Video 1

Post-Procedure Video 2

Post-Procedure Video 3

 View blood flow through the carotid arteries, supplying critical blood to the brain.

Clogged Artery

Carotid Stent

Improved Blood Flow

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