Fresno Heart & Surgical enrolls most in state to carotid stenting research

Dr. Rohit Sundrani has become the state's top enroller in the Sapphire stenting trials.

In the year since launching Fresno Heart & Surgical Hospital’s first research project, interventional cardiologist Rohit Sundrani has become the state’s top enroller in the Sapphire stenting trials.

Dr. Sundrani has completed the most procedures for research designed to show that carotid stenting is more effective than surgery in preventing strokes when there is fatty plaque buildup in the main artery feeding blood to the brain. The work at Fresno Heart & Surgical has contributed more data than Stanford or UCLA medical centers, bringing Medicare closer to approving this for a wider group of patients, he said.

Right now the Medicare-approved guidelines say the non-surgical option should only be offered to patients who already have numbness in their limbs, trouble talking or trouble moving – all signs of stroke. Fresno Heart & Surgical is one of a handful of hospitals in California that is approved through the Sapphire research project to perform carotid stenting on a larger group of patients with lesser risk in an effort to show this might be the preferred treatment.

“The biggest concern has been how long the stents last,” explained Dr. Sundrani. “The stents are holding very well and are equal or better than surgery to keeping the carotid from narrowing again.”

Dr. Sundrani outlined his success rate in the Sapphire trial: “I’ve done 50 patients so far and they’ve all done great. There’s been no major strokes or heart attacks and 90% of them go home the same day … The initial guy we did stenting on went out skiing the next day.”

Patients have come from all over the Valley – Hanford, Dinuba, Oakhurst, Visalia. “Most of them have been referred by surgeons who feel this is a better option,” Dr. Sundrani said.

Normally, when the main artery supplying blood to the brain is blocked or partially blocked, surgeons cut open the neck and scoop out the plaque in the carotid artery.  But for many patients with heart problems, diabetes or a history of blood clots, a stent is a safer option.

Patients remain awake during the stenting procedure and the incision is not much larger than a needle prick in the groin. A small, thin tube is snaked through an opening in the groin up through the arteries to the neck. The catheter helps push the stent – a small mental tube – up into the narrowed portion of the carotid and a small mesh basket filter grabs fatty plaque and pulls it out as the catheter is removed.

Prior to the study patients had to go to the Bay Area to have the same procedure done by other cardiovascular specialists. Dr. Sundrani was the first cardiologist in Fresno trained and experienced in carotid stenting. And even though he has been performing carotid stenting for the past three years in Fresno, he could only do it on the sickest patients, those who were already experiencing stroke symptoms.

This story was reported by Erin Kennedy. She can be reached at ekennedy@communitymedical.org.

Friday, June 12, 2009