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| Vol. 23, No. 02 |
| February 1, 2001 |
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All Clear Here By JONATHAN LOWE Memorial Hermann Healthcare System
Many people dream of retiring before they turn 40. For Jeff Gregory, it was a life or death decision. When he retired at 39 from Paine-Webber, where he was a portfolio manager, Gregory had already experienced two heart attacks. Now 48, he has five angioplasties behind him and was recently a candidate for groundbreaking surgery at Memorial Hermann Hospital. "I had a nice income, but was under a great deal of stress," Gregory says. "I used to work out really hard to counteract the stress of my workday. Because I exercised vigorously, I would never have thought I'd be a candidate for heart problems. Unfortunately, my family history said otherwise." Gregory, like more than 25 million people worldwide, copes with coronary artery disease, the leading cause of death in the United States. This year alone, an estimated 1.3 million procedures such as balloon angioplasties and stents will be performed to re-open blocked arteries. In December, tests revealed new blockage in yet another of Gregory's arteries. Tests also showed that one of his stents, placed during a September procedure, had re-occluded 70 percent. Between 30 and 50 percent of angioplasty patients and 20 to 30 percent of stent patients experience re-stenosis, or re-narrowing of an artery within six months. This re-narrowing process may lead to chest pain (angina), shortness of breath and potentially a heart attack. "I really started to worry because I'm not a good candidate for bypass surgery," Gregory says. "I've had severe damage to my left ventricle function, so what I really need is for my heart to pump through open arteries." Gregory's hopes were renewed when he learned that angioplasty patients at Memorial Hermann Hospital are among the first in Texas to receive treatment using beta radiation technology. Doctors at the hospital began treating patients with re-narrowed stents last month using intracoronary brachytherapy, or in-heart radiation. Following an angioplasty to re-open a narrowed stent, doctors position a beta radiation catheter in the coronary artery. This catheter allows temporary delivery of beta radiation to the site of interest for three to five minutes. The goal of the radiation treatment is to inhibit the overgrowth of normal tissue as the healing process occurs following angioplasty or after stent placement. Clinical trials with the beta-cath system showed a greater than 50 percent improvement rate in re-narrowing of arteries, compared to patients not receiving vascular brachytherapy. "We're using a unique closed-end catheter design, which uses hydraulic force to deliver the radiation sources to the angioplasty site," says Dr. Oscar Rosales, medical director at Memorial Hermann Hospital's Coronary Care Unit. "The sources, which contain beta radiation, never come in contact with the patient's tissue or blood and remain at the treatment site for less than five minutes before being withdrawn. The procedure adds less than 10 minutes to the total angioplasty time and is believed to pose no additional risks to the patient." "The procedure was designed to be easily adapted into the cardiac catheterization laboratory without requiring any additional radiation protection," says Dr. Richard Smalling, medical director at Memorial Hermann Hospital's Cardiac Catheterization Lab. "Beta radiation is much less invasive than gamma radiation, which is typically used to treat cancer, and is therefore much more easily shielded," Dr. Smalling says. "We're able to remain at the patient's side during the treatment because the radiation exposure to the patient and health care workers is greatly minimized." The beta-cath system is further supported by doctors' use of a cutting balloon, which uses microsurgical dilation to open diseased arteries minimizing the tissue overgrowth that contributes to artery re-narrowing. Longitudinally mounted blades cut through the blockage. The balloon is folded to shield the blades and protect the vessel wall as the catheter is passed to and from the lesion. New technology like this gives patients like Jeff Gregory fresh optimism that coronary artery disease, if not curable, is at least treatable. "To me, this is a positive development in heart treatment that will keep my arteries open and give hope to other folks like me," Gregory says.
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