By Michaela Gibson Morris
Heart specialists in Northeast Mississippi have good reason to be at the forefront of advances in care.
“Unfortunately, there’s a high prevalence of heart disease in this region,” said Tupelo cardiologist Dr. Barry Bertolet. “You want to be able to deliver the very best therapies.”
In the past few months, Tupelo and Oxford cardiologists can claim an impressive set of firsts, helping to bring new therapies for heart attack and coronary artery disease to patients.
New stent tricks
For years, cardiologists have used catheters – thin wires – to clear blocked arteries and placed stents – narrow mesh tubes – to keep coronary arteries from closing up. It keeps blood flowing to the heart, and patients recover quickly from the minimally invasive procedure.
In August, North Mississippi Medical Center-Tupelo was the first in the nation to use a new kind of self-expanding stent – Stentys – as part of an international research study focused on people having heart attacks because of a completely blocked coronary artery.
“This is brand new technology,” Bertolet said.
For good outcomes, it’s important that the stent fits well. If the stent is too large, it can rupture the blood vessel, sending the patient for emergency open heart surgery, Bertolet said. If it’s too small, the risk of clots increases. With most people, cardiologists are able to size with no problem.
People having active heart attacks can be difficult to size. A heart attack starts with a chain reaction inside a coronary artery irritated by plaques – deposits of calcium and fatty substances inside the blood vessel.
“The plaque blows its top like a volcano,” Bertolet said.
The blood vessel itself goes into spasm, tightening up, as substances in the blood stream try to clot to try to repair the damage – just as they do when you cut your finger. The tighter space and the blood clots combine to cut off blood flow to the heart muscle, causing the attack.
At the hospital, the cardiologist removes as much of the clot as possible and usually places a stent to keep the vessel open.
“In time, the vessel relaxes back and clots disappear,” Bertolet said.
That means the stent that was just the right size during the heart attack, is now too big and the rate of complications goes up.
“The (self-expanding) stent will actually expand as the blood vessel expands to reach normal size,” Bertolet said.
Early results in the study look promising.
“We’ve put more in than anyone else,” Bertolet said.
At Baptist Memorial Hospital-North Mississippi in Oxford, Dr. Stevan Himmelstein was the first to use the Diamondback 360 Coronary Orbital system to clear plaque-clogged coronary arteries after it was approved by the FDA in November.
“Coronary artery disease occurs when plaque builds up on the arterial wall, causing the arteries to harden and reducing blood flow,” Himmelstein said. “It is the most common form of heart disease in the United States.”
Plaque is a combination of calcium and fatty materials like cholesterol and triglycerides that can build up on the walls of arteries. Higher levels of bad – LDL – cholesterol encourage the formation of plaques. Good – HDL – helps to scrub it out of the arteries. The plaque can build up to the point it closes off the artery. It also can irritate the lining of the blood vessel so much it sets off the chain of events that causes a heart attack.
But the plaque isn’t easy to remove. The traditional angioplasty doesn’t work well on arteries filled with the calcified plaques, Himmelstein said.
“It’s like trying to open a balloon in concrete,” Himmelstein said.
The Diamondback system is a tiny diamond-coated sander on a catheter inserted through the artery in the thigh. The cardiologist controls how fast the crown spins. If the sander is offset instead of being mounted straight on the catheter. It means a tiny crown can do big things for restoring blood flow.
“It wobbles,” Himmelstein said. “It can spin faster and open up a bigger channel.”
Himmelstein, who is part of the Stern Cardiovascular Foundation, had been involved with the Diamondback trial for several years. He was involved with designing the trial and enrolled 32 patients in the trial over 21⁄2 years while he cared for patients at Baptist Memorial Hospital-Desoto County in Southaven before coming to Oxford in April.
Since December, he’s treated about 20 more patients in Oxford with the Diamondback.
During the trial ahead of FDA approval – where patients had a stent after their arteries were cleared with the Diamondback – only one of Himmelstein’s 32 patients had to be restented because the artery had closed again; none have required bypass surgery.
“Typically, you would expect 5 to 10 percent with drug-eluding stents,” would have a reoccurrence of the blockage, Himmelstein said.
Roughly 15 to 20 percent of patients who undergo procedures to try to clear arteries of plaque build up end up needing emergency bypass surgery or having a heart attack during the procedure.
“This is a high-risk population,” Himmelstein said. “It’s turned out to be a very safe device.”
HEART ATTACK WARNING SIGNS
Some heart attacks are sudden and intense. But most heart attacks start slowly, with mild pain or discomfort. Often people affected aren’t sure what’s wrong and wait too long before getting help.
Here are signs that can mean a heart attack is happening:
• Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
• Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
• Shortness of breath. May occur with or without chest discomfort.
• Other signs: These may include breaking out in a cold sweat, nausea or lightheadedness.
• If you or someone else has chest discomfort, especially with one or more of the other signs, don’t wait longer than a few minutes (no more than 5) before calling for help. Call 9-1-1… Get to a hospital right away.
Source: American Heart Association
• Feb. 7 is National Wear Red Day to raise awareness of women’s heart health.
Fridays in February
• 10 a.m. to 1 p.m. Fridays in February: Free blood pressure screenings and heart health information in NMMC-Tupelo lobby.
• 10:30 a.m. “Warning Signs of a Heart Attack,” free presentation at NMMC Wellness Center, Tupelo.
• Noon, Women in Red Luncheon at Feb. 18 at First Baptist Church Fellowship Hall. Speaker will be Dr. Barry Bertolet. Lunch will be provided for $5 for those who preregister by Feb. 12, by calling (800) 843-3375.
• 10:30 a.m. “New Heart Valves” free presentation at NMMC Wellness Center, Tupelo.
• Women’s Health Conference will be 8 a.m. to noon Feb. 21 at Crossroads Arena conference room in Corinth. Free event sponsored by Magnolia Regional Health Center. Registration required. Visit mrhc.org and click Classes & Events.
• 10:30 a.m. “Beyond the Cath Lab: Structural Heart Disease” free presentation at NMMC Wellness Center, Tupelo.