The Herald, Sharon, PA Published Sunday, Feb. 11, 2001
outlook 2001


IVUS looks at clogged arteries
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Device is inserted to check plaque

By Michael Roknick
Herald Business Editor

Anyone undergoing a heart-bypass has the same story.

After the surgery they feel as if their chest has been hit by a train. The invasive surgery can take months of recovery and time away from work or leisure activities.

As an alternative, medical science came up with the "balloon’’ in the 1970s. This device is inserted into a clogged artery and is expanded with the aid of a stent to open up the artery.

The advantage of balloons are they have a faster recovery time for patients.

But science has created a new piece of equipment that can view the inside of arteries to check their condtion.

Called the Intravascular Ultrasound, this equipment is shaped like a tiny football that allows doctors to see the condition of an artery before and after a procedure to open the artery.

In a small percentage of cases a new piece of equipment --- the Directional Coronary Atherectomy, can take out pieces of plaque by slicing it much like a kitchen food processor.

Both pieces of equipment are being used by Sharon Regional Health System’s Heart Institute.

"This has opened up a whole new world of knowledge,’’ said Dr. James Landis, director of the institute.

Affixed at the end of a catheter, the IVUS uses miniature ultrasound waves offering surgeons a three-dimensional view of what the inside of an artery looks like. It can also let the surgeon know if the plaque is hard or soft.

Once the IVUS cleans out an artery it shows the surgeon if they’ve been successful.

"It’s like looking down into a tunnel,’’ Landis said. "IVUS allows you to check the vessel and go back in and smooth out any rough edges.’’

Before IVUS doctors could only make their best guess on whether a balloon had been successful.

Under the procedure patients are sedated with the average case lasting one to two hours. Candidates for the procedure are those with 70 percent blockage or greater. Arteries with less than 70 percent blockage can be treated with medication.

As long as the wire attached to the IVUS can poke through the plaque it can be used. Even in the case of complete blockage the wire can poke through about half of the time, Landis said.

A surgeon inserts the wire, which is a delicate fourteen-thousandths of an inch thick, down the artery. The IVUS slides down the wire giving the doctor a view, which is shown on a monitor. Doctors can use IVUS before and after a procedure.

IVUS gives surgeons more options, Landis noted. Someone with a single blocked artery can have better results with a balloon procedure than going through a full-blown bypass.

"For a single artery blockage you’re using a big club with a bypass,’’ Landis said.

With heart-bypass comes a greater risk during the surgery. A big advantage of using a balloon is the patient can go home the next day.

"You’re toast for the next 12 weeks after a by-pass,’’ he added.

Given the 95 percent success rate, using a balloon is gaining in popularity.

"The long-term results, with the use of IVUS has improved dramatically,’’ he said.

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