Fresno Heart & Surgical approved for cardiovascular research

Dr. Rohit Sundrani inserts a catheter through a small opening in his patient's groin.

Interventional cardiologist Rohit Sundrani intently studied the video screen above his patient as he snaked a small, thin tube from a tiny opening in his patient’s groin, through her arteries up to her neck. As he guided the catheter into the carotid artery, which supplies blood to the brain, he called out to his elderly patient: “Squeeze the toy please, sweetie.”

Squeak, squeak, squeak sounded in the Fresno Heart & Surgical Hospital’s procedure suite. Dr. Sundrani smiled and nodded. Squeaking on cue meant his patient was responsive and her brain was fully functioning, unaffected by the maneuvering so close to the main blood source. A few minutes later, Dr. Sundrani pushed a small metal tube up into the narrowed portion of the carotid and pulled a miniscule mesh basket filter back through grabbing fatty plaque on the way out.

Dr. Rohit Sundrani removes air from a stent.

Just six months ago, Dr. Sundrani was taking patients like this one 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.

Now, he does the same procedure here at Fresno Heart & Surgical Hospital for an expanded group of patients through a newly approved trial – the hospital’s first research project. In the Sapphire stenting trials, he also treats patients at risk of stroke who have other conditions that make anesthesia and surgery risky.

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 procedure and the incision is not much larger than a needle prick in the groin.

Studies show that the risk of heart attack and stroke are less with a carotid stent than with surgery to fix the same problem, Dr. Sundrani said.

Dye injected into the patient shows improved blood flow through the arteries.

 “And there’s no big scars, or risk of nerve injury in the neck,” he added, detailing the advantages. “Patients go home the next day rather than a couple of days in the hospital. The initial guy we did stenting on went out skiing the next day.”

Before Dr. Sundrani removed the catheter from his 80-something female patient, he injected contrast dye to see how her blood was flowing. The improvement was marked. New branches of arteries into the brain were suddenly visible on the video screen. With each heart beat, the carotid showed blood coursing through strongly upwards. The plaque that had been slowing the flow was pushed out of the way by the stent, securing it against the artery wall so that there was no longer a danger of it breaking off and lodging in the brain, causing a stroke.

Dr. Sundrani said further research should show the advantages of offering the carotid stent to a larger group of patients, rather than just high risk patients.

“We have 2,000 patients enrolled in this trial throughout the country. Eventually it will be expanded to low-risk patients as well,” he said.

Right now the Medicare-approved guidelines say it 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.

Such research brings more options to Valley residents and eventually opens the way for Fresno Heart & Surgical to do more research trials, said Julie Cleeland, executive director of business development and marketing.

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

Tuesday, February 26, 2008