“There’s no way to put into words the thanks I have,” says Karen, a self-employed mother of four from Bergen County. Karen was diagnosed with early-stage breast cancer after receiving a mammogram made possible thanks to funds raised from the Walk for Awareness. After early intervention and treatment, Karen is doing well.
Posted November 3, 2017
October 31, 2017 — Englewood Hospital and Medical Center has earned an “A” designation from The Leapfrog Group, a national nonprofit health care ratings organization, for the 12th consecutive time since 2012 — one of only 59 hospitals in the United States and 3 in New Jersey to achieve this record.
“As the healthcare industry continues to evolve, our efforts to improve patient safety and quality are unwavering,” said Warren Geller, president and CEO of Englewood Hospital and Medical Center. “Earning an “A” rating from the Leapfrog Group for the 12th straight scoring period is a testament to the tireless efforts of our entire staff that work to ensure that our patients receive the best, and safest, medical care.”
“We applaud all hospitals that earn an A for safety, a significant achievement. Englewood Hospital and Medical Center takes that achievement one step further by earning an A year after year,” said Leah Binder, president and CEO of The Leapfrog Group.
Developed under the guidance of an expert panel, the Leapfrog Hospital Safety Grade uses 27 measures of publicly available hospital safety data to assign A, B, C, D and F grades to more than 2,600 U.S. hospitals twice per year. It is calculated by top patient-safety experts, peer reviewed, fully transparent and free to the public.
Heart disease is the leading cause of death for both men and women in the United States according to the Centers for Disease Control. High blood pressure, high cholesterol and smoking are all significant risk factors for developing a cardiovascular condition. Today, there are many new advances to treat heart disease and save lives. We talked with cardiologist Dr. Joseph De Gregorio, section chief of Invasive Cardiology at Englewood Hospital and Medical Center, about heart disease and his team’s approach to treating and managing it.
Q: What do you find most exciting about treating patients with heart disease today?
Dr. De Gregorio:
There are great advancements in the technology that allows us to do more in a less invasive fashion. In cardiology, we are able to fix a lot of the problems that we find and we can do it with less invasive procedures than even just a decade ago. Things have changed a lot in the 20 years that I’ve been practicing medicine. For example, critically ill and elderly patients who were too high risk for certain procedures in the past can now be helped tremendously. We are able to save lives and improve the quality of life for patients for whom there were no options even just a few years ago.
Q: Are there new technologies that improve care for patients?
Dr. De Gregorio: TAVR—One of the most dramatic differences is in aortic disease, which commonly occurs in elderly or very elderly patients. In the past, the only option was surgery to replace the damaged valve, which could be very high risk, especially for patients with co-existing conditions, and the recovery from surgery can really be very traumatic. Now we can put a new valve into the heart through catheters, which is much less invasive, the recovery is much quicker and the patient generally goes home the next day.
At Englewood Hospital, we were one of the first hospitals in the country to perform transcatheter aortic valve replacement (TAVR) after it was FDA approved in 2011. TAVR provides a treatment option for patients with severe aortic stenosis who are at intermediate to high-risk for cardiac surgery. We perform these procedures as a team with Englewood’s cardiothoracic and vascular surgeons and have treated over 250 patients with a high success rate and outcomes better than the national average.
Absorbable Stents were FDA approved last year after clinical trials in which Englewood Hospital participated. A traditional metal coronary stent acts as scaffolding to open up the artery. The absorbable stent is the evolution of the technology. These new stents start to be reabsorbed at six months. The idea is that you don’t need the stent anymore because the artery has healed in an open position. Right now, it’s not for everyone, but in the future perhaps this will be standard treatment. We’re trying to help evolve this technology.
Other new catheter-based technologies include MitraClip to treat mitral valve regurgitation, chronic total occlusion PCI, for opening total coronary blockages, and Impella®, a life-saving device used to sustain circulation for critically ill patients at high-risk for an interventional cardiology procedure.
Q: What sets your cardiology practice apart from others?
Dr. De Gregorio: At Bart De Gregorio, MD, LLC, we have eight cardiologists in our practice and each is specialized. We have expertise in each subspecialty of cardiology to care for adult patients of all ages with any kind of heart condition. We’ve structured our practice so that can each physician can be very efficient in applying their expertise. For example, I’m based onsite at Englewood Hospital for invasive procedures and to see patients in the hospital. We have the efficiency and personalized touch of a smaller practice.
In our office in Glen Ridge, we perform all outpatient non-invasive testing for diagnosing cardiovascular disease, including: nuclear stress testing, echocardiography, Holter monitors, carotid artery and peripheral vascular disease testing, CT angiography and more allowing us to perform tests and interpret all results right in our office. This means we can provide specialized expertise and a superior level of quality and convenience for our patients.
Our philosophy has always been to provide the best quality of care. However, it’s not just having skilled physicians who understand how to diagnose and treat cardiovascular disease, but also about how we treat the patient as an individual. We have a highly personalized environment. We know our patients and their families and they know us. We’ve created an environment where patients feel comfortable – including with our staff, in our office setting, and in their relationship with their physician. If a patient calls up and says they are having a symptom, we act quickly. We are very available and active in treating patients.
Q: How does teamwork improve care for patients?
Dr. De Gregorio: Part of what makes Englewood Hospital unique is the collaboration between specialists in the Heart and Vascular Institute. We have a real team approach and camaraderie which results in optimal care for the patient. Collegial relationships among the specialties allow us to be involved with some of the newest technological advances to treat cardiovascular disease. It is an incredibly important aspect of our care for certain patients, such as TAVR, where interventional cardiologists, cardiothoracic surgeons and vascular surgeons all have a role in the procedure.
Q: What is the most important takeaway?
Dr. De Gregorio: The great thing about cardiology is that we find problems and we treat problems: most often this can be done with minimally invasive methods. You want to address things early. When we find things earlier, they can be treated before they cause any problems. We have ways of treating your condition that are safe and effective, so it’s important to be evaluated.
Posted October 2017
As the summer break comes to a close, it’s time to start prepping for back to school. With so much to do before the first day, it’s easy for families to get overwhelmed. We sat down with Dr. Alexandra Gottdiener, chief of medicine and medical director of the Braverman Family Executive Wellness Program at Englewood Hospital and Medical Center, and Nina Spiegel, a holistic nutritionist at the Graf Center for Integrative Medicine at Englewood Hospital and Medical Center, to discuss ways to start the school year off right.
Q: As both parents and their children prepare for the new school year, what do you recommend for a healthy start?
Dr. Gottdiener: Prepare as much as possible in advance. I recommend the following:
1. Make a wellness appointment.
Before starting school, your child should get a wellness exam, including a physical, eye, and dental checkup. Make sure to check with the school beforehand to learn of any immunization requirements and recommendations.
2. Fill prescriptions and submit any health forms.
Notify the school and submit any health forms if your child has a health condition, being sure to identify triggers. For certain conditions, such as asthma or an allergy, your child may be permitted to carry medication.
3. Establish a regular sleep and meal-time schedule.
Sleep is essential for children’s development. An established routine can help make the transition to a school schedule easier. Children and teens should get at least 8 hours of sleep every night. As electronics can impact sleep, children and teens should store them away at least an hour before bed.
Meals should coordinate with your child’s school schedule. Don’t forget about breakfast! Skip the sugary cereals in favor of a hearty breakfast that combines lean protein, good fats like avocado, and complex carbohydrates made from whole grains to help fuel your child in the morning.
4. Remind children about good hygiene and safety practices.
Washing hands after sneezing or coughing, as well as before and after meals, can help prevent the spread of germs. To avoid injury to the back or neck, make sure any backpack used is not too heavy.
Nina Spiegel: Shop and prepare healthy meals and snacks.
At the beginning of each week, make a list of different meals you and your family can put together and have for the rest of the week based on tastes, preferences, and any diet restrictions. Last night’s meal can easily be turned into a new dish with a little bit of creativity. For example, chicken or vegetable stock can be added to leftovers of chicken, pasta, and vegetables to become tomorrow’s lunchtime soup.
As a family, learn about proper portion sizes, how to read labels for nutritional content, and healthy eating on the go.
Dr. Gottdiener: Also, practice stress management. Children, tweens, teens – and parents – have to balance a lot of activities, so it’s never too early to learn techniques to reduce anxiety and/or stress before and after school.
The Graf Center offers evidence-based sessions in yoga, therapeutic massage, meditation, stress management, nutritional counseling, and reflexology, among other relaxation services, that may be beneficial to both parents and their children. Starting in the fall, the Graf Center also will offer a back to school wellness package, healthy cooking classes, and mindfulness events to help families transition into the new school year.
For more information on the Graf Center for Integrative Medicine, call 201-608-2377, and for more information on the Braverman Family Executive Wellness Program, call 201-608-2355.
Posted October 2017
Love at first sight is a particularly illusive kind of magic, the existence of which has been debated for centuries. But if you ask Matthew Antonelli, he’ll tell you he knows it to be real — because he it felt it the second he laid eyes on Carolina. He took one look at her curly head of hair and her bright smile and knew instantly that she was the one for him. It wasn’t long before he got down on one knee and a proposed atop a snowy mountain.
“It was a fairytale. I found the right girl, we got married and then it gets even better — she’s pregnant. But then it just goes downhill,” he says.
Fourteen weeks into her pregnancy, Antonelli was diagnosed with cervical cancer. The couple faced a nearly impossible decision.
“We knew we wanted a family. We wanted this baby more than anything. It was a tough situation to accept,” Antonelli says.
The choice of whether or not to terminate the pregnancy in the interest of her own health plagued the couple. They worried that following through with the pregnancy might endanger mother and baby, but terminating meant losing the possibility of a future with biological children.
In recent years, cervical cancer has become somewhat rare. It was, and still is, even rarer to have cervical cancer during a pregnancy.
“We had to perform a robotic pelvic lymphadenectomy during her second trimester to make sure the cancer hadn’t spread to the lymph nodes,” says Nimesh Nagarsheth, MD, director of gynecologic oncology and director of robotic surgery. “In all the world’s literature we have, this was only the second time this procedure was performed. After confirming that the cancer hadn’t spread, Carolina was able to choose to keep the pregnancy.”
After her surgery, Antonelli underwent chemotherapy. “We did our research; we visited other hospitals. But nothing gave us the warm feeling we got at Englewood Health. They gave us the positive atmosphere and reassurance we needed,” Mr. Antonelli says. He was at her side every day and, within a few months, a healthy baby girl was born.
“Angelina is the sweetest little girl. She’s such a miracle. I’m so grateful to Englewood Health. Because of them, I have a beautiful family and a lot to look forward to,” Antonelli says.
Posted September 18, 2017
High-risk cardiology patients in northern New Jersey now have the opportunity to undergo transcatheter aortic valve replacement (TAVR) at Englewood Hospital and Medical Center, one of the first hospitals in the country to offer the procedure since the FDA approved it in 2011.
Thanks to the efforts of Englewood Hospital’s staff of cardiology experts and its reputable surgical infrastructure, it was able to become a major center to offer TAVR to high-risk patients who have severe aortic stenosis or who are not considered ideal candidates for open-heart procedures. Since then, Englewood Hospital has performed the procedure on 250 of these patients.
“We’re operating on patients in their 70s, 80s, and well into their 90s. Formerly, referring physicians and cardiologists would never have thought of sending patients that old for a procedure, and they would just be stuck at home feeling unwell,” said Adam Arnofsky, MD, a cardiothoracic surgeon at Englewood Hospital and Medical Center. “Now we have a procedure we can offer them with a very quick, easy recovery that can get them symptom-free and really turn their lives around.”
Initially, the manufacturer of the TAVR device was very conservative in identifying centers with which it wanted to be involved. “They were rolling the device out in a very particular way, where they wanted the proper operators and a specific surgical setup. We fit the bill,” said Joseph De Gregorio, MD, section chief, invasive cardiology at Englewood Hospital and Medical Center.
Since TAVR was introduced at Englewood Hospital, the program has grown dramatically each year. The heart team performed more than 100 TAVR cases in 2016 and expects substantial growth in 2017, especially since the FDA has approved the device for intermediate-risk patients in addition to the high-risk patients for whom it was already approved. “That expanded the procedure tremendously,” Dr. De Gregorio said.
Englewood Hospital’s cardiac surgeons and cardiologists have observed a high success rate in TAVR patients, with outcomes better than the national average. Dr. De Gregorio attributes this success to the multidisciplinary approach.
“This takes a real team approach, and we have an excellent team in place, which is not common in most centers,” he said. “That’s really why we’ve done so well.”
With their TAVR program well underway, the team is now set to embark on their next project: the MitraClip. “That’s expanding the transcatheter structural heart therapeutics to the next level,” Dr. Arnofsky said. “This is the first procedure that’s been FDA approved to correct mitral valve abnormalities in high-risk patients who are not candidates for an open procedure. We have performed several MitraClip procedures so far.
“Englewood Hospital has been a great place to work,” said Dr. Arnofsky, who has been with the hospital for eight years. “The collegial relationships we have among the departments allow us to be involved with some of the highest, newest technological advances out there to treat patients with cardiovascular disease.”
Another technological development is an absorbable coronary stent. Dr. De Gregorio was one of the investigators involved in a three-year-long clinical trial of the stent, which was approved by the FDA last year.
“When people have blockages in their coronary arteries, we’ve historically used metal stents that act as scaffolding to open up the area blockage. But those stents stay in forever. The artery grows around it, and the stent becomes embedded, a permanent part of the arterial wall,” he said.
These new stents, which are made of polylactic acid, start to be resorbed by the body at six months. By the end of three years, they are often completely resorbed. “The basis of this is that by six months you wouldn’t need a stent anymore because the artery has healed in an open position,” Dr. De Gregorio said.
“Englewood was one of the few centers involved in the trial, and we can now offer that procedure. If we can make a resorbable stent that’s as easy as the metal stent in terms of usability, we’d be better off using the resorbable stent. We don’t like to leave things behind; we like arteries to return to their normal state.” It is possible that future generations of the resorbable stent could replace metal stents in most situations, he added.
Dr. De Gregorio, now in his 11th year as co-director of the annual Complex Interventional Cardiovascular Therapy (CICT) meeting, an educational conference dedicated to discussions of structural and interventional therapies, gave a presentation on the absorbable stent at the meeting, which took place at the end of July in San Francisco.
Although open-heart surgeries are common, Englewood Hospital and Medical Center is committed to providing less invasive options. One such option, transcatheter aortic valve replacement (TAVR), allows physicians to repair an old or damaged valve without actually removing it. Another, endovascular aneurysm repair (EVAR), involves making a small incision in one or two arteries in the groin and inserting a catheter to guide a graft into the aneurysm. The benefit of this procedure is that there is no need for abdominal surgery, and it has fewer associated risks and a short recovery time.
A TAVR procedure may become more complicated if a patient has an aneurysm that requires intervention from a vascular surgeon. This is where Englewood Hospital’s multidisciplinary approach comes into play.
The seamless coordination between Englewood Hospital’s cardiac and vascular surgeons allows for smooth handoffs of those patients who require additional interventions. An advanced and minimally invasive technology that has come out of this process is fenestrated EVAR grafts, which give vascular surgeons the ability to navigate and fix aneurysms while maintaining the integrity and structure of the valves and veins. This is an advanced technique, and with fenestrated grafts, more patients with different anatomies can be treated, as the devices can fit almost all patients.
“Fenestrated devices can now be used to treat more and more patients because 30% of patients had anatomies that didn’t fit a standard,” said Michael Wilderman, MD, a vascular surgeon at Englewood Hospital. “As the devices get better, we’ll be able to treat almost all patients with minimally invasive procedures as opposed to open surgery.”
Fortunately, the cardiac and vascular surgeons at Englewood Hospital can decide the best course for individual patients with abdominal aortic aneurysms and which of the two types of EVAR procedures (standard and complex) they should receive.
Posted September 2017
“Even before I came here, Englewood Hospital had in place high-end technology for vascular surgeons to perform advanced procedures,” said Thomas R. Bernik, MD, chief, vascular surgery at Englewood Hospital. “A lot of our physicians are New York City transplants, including myself. We have the technology here, the medical teams and the administrative support that I really didn’t have in New York City. It was one of the attractions for me to come here.”
Dr. Bernik came to Englewood Hospital in January 2016 from Mount Sinai Beth Israel, in New York City, where he was an associate professor of surgery and chief of vascular surgery. Prior tothat, he was chief of endovascular surgery at St. Vincent’s Hospital and Medical Center, also in New York City. As a vascular and endovascular surgeon, Dr. Bernik specializes in complex open surgery and minimally invasive surgery for aortic aneurysms, carotid disease, peripheral vascular disease, dialysis access and complex venous thrombosis.
Dr. Bernik is continuing to expand the hospital’s vascular surgery services and oversees the leadership of the Wound Care/Limb Salvage Center.
Englewood Hospital’s programs are multidisciplinary, which foster and individualize patient care. Doctors, even those at major big-city academic hospitals, tend to work in silos, Dr. Bernik said, and operate within their specific disciplines.
“The uniqueness of what we have here is the multispecialty design of the programs,” Dr. Bernik said. “We start with a very good vascular surgery base of physicians, but we also have support from all the different disciplines that we bring into our programs, helping us give the quality of care that is needed.”
For example, the Wound Care Center brings in specialists from infectious diseases, vascular surgery, cardiology and endocrinology to provide comprehensive, whole-body care. “These are some of the sickest patients that you are going to have in the hospital from a cardiovascular standpoint,” Dr. Bernik said. “They have multisystem organ issues.” These include coronary artery disease, lung disease or kidney disease, he noted, and all of those specialties should have a say in the treatment of that patient.
Because vascular issues can affect the entire body, “we have multispecialist practices that participate in the care of the one patient,” Dr. Bernik said. “The biggest thing we do for the care of patients who are really sick is maintain our focus on quality, quality, quality.” That focus on quality has been consistently recognized by external rating agencies, including CareChex, a division of Quantros, Inc., which recognized Englewood Hospital’s vascular surgery division as being among the top 10% in New Jersey and the nation for both medical excellence and patient safety in 2016.
Posted September 2017
Now more than ever, it is an exciting time to be caring for patients with heart and vascular disease. New developments in technology, rapidly expanding expertise in surgical and catheter-based treatments, and new treatment options derived from national clinical trials in which Englewood Hospital and Medical Center has participated have greatly expanded the options available for treating patients, including the critically ill and elderly.
At the Heart and Vascular Institute at Englewood Hospital, we are dedicated to patient- and family-centered care for those with heart and vascular conditions through a full range of treatment options that match those provided by the most highly regarded academic medical centers in the region. We have a proud history of service: Our team has performed more than 4,000 open-heart surgeries since we began this program in 2000, and it has one of the lowest mortality rates in the state for coronary bypass surgery. Last year alone, we performed more than 100 transcatheter aortic valve replacements (TAVRs) for treating severe aortic stenosis; and for more than two decades, we have been an international leader in patient blood management and bloodless surgery, which has been shown to significantly reduce the incidence of serious and life-threatening postoperative complications, including for open-heart surgery.
As ever, we are engaged in continuous improvement to drive forward quality and outcomes. With new energy, we are enhancing the Heart and Vascular Institute by aligning our efforts under four centers of excellence: structural heart disease, coronary artery disease, aortic disease and arrhythmia management. Together our surgeons, interventional and noninvasive cardiologists, cardiac electrophysiologists and vascular surgeons are working toward improving access, expanding treatment programs, pushing quality even higher, and aligning ourselves with efficient partners as we prepare for and participate in new payment models that demand the highest quality.
Among our resources for referring cardiologists and primary care physicians are recent innovations: an Impella program to support patients in cardiogenic shock or severe heart failure and complex coronary interventions; the TAVR program for treating severe aortic stenosis; the WATCHMAN device for left appendage closure to reduce the risk for stroke in people with atrial fibrillation; MitraClip procedures for managing inoperable mitral valve disease; transcatheter interventions for chronic total coronary artery occlusions; and thoracic endovascular aortic repair, a minimally invasive procedure to address aortic aneurysms. Many of these new procedures are alternatives to major surgery, giving critically ill or elderly patients a previously unavailable option.
Our expertise in these areas makes Englewood Hospital and Medical Center a leader in advanced cardiovascular care. Our goal is to work closely with cardiologists, and other referring physicians, throughout the region to ensure that all adults with heart and vascular disease can be treated close to home, with the highly personalized care for which Englewood Hospital is known.
Posted September 2017
“We are a high-quality, high-volume center,” said Grant Simons, MD, section chief, heart rhythm services at Englewood Hospital and Medical Center’s Heart and Vascular Institute. “We have the most advanced mapping and ablation technologies available. For example, we’re able to use 3-D mapping of atrial fibrillation to pinpoint problems in time and space with the clearest possible computer-rendered images.”
In fact, the reputation, experience and expertise of Dr. Simons and Englewood Hospital’s electrophysiology team were why the hospital was chosen as northern New Jersey’s first hospital to implant the WATCHMAN Left Atrial Appendage Device (Boston Scientific) for nonvalvular atrial fibrillation. The WATCHMAN device, which the FDA approved in 2015, is implanted into the heart’s left atrial appendage via a delivery catheter in the femoral vein to prevent blood clots from entering the bloodstream and causing ischemic stroke.
“While blood thinners can be effective, they have the potential for some dangerous side effects,” Dr. Simons said. “The WATCHMAN implant is actually a safer alternative to blood thinners, and it is more effective at reducing stroke risk among patients with atrial fibrillation. It also means a patient no longer needs to take blood thinners for the rest of his or her life.”
Although the relatively new procedure is only covered by insurance if a patient is considered an unsuitable candidate for long-term blood thinners, it is gaining traction. The procedure is relatively quick, taking anywhere from 45 minutes to 1.5 hours, and patients go home the next day requiring only a short-term course of anticoagulants.
“As awareness of the WATCHMAN increases, we’ve become a destination for this procedure and the LARIAT procedure, as well as cryoablation and mapping of atrial fibrillation,” Dr. Simons said. The LARIAT procedure is a minimally invasive alternative for patients with atrial fibrillation who are unable to take blood thinning medications. “We’re recommended because we have a very low complication rate, innovative technologies, a dedicated nurse practitioner program and a patient-centered system that quickly connects patients with physicians. We’ve eliminated that waiting-around, lost-in-the-system feeling,” Dr. Simons added.
In addition to the patient-oriented approach, the electrophysiology team works collaboratively, relying on decades of experience. “The team at Englewood is extremely experienced and that makes a huge difference when you’re working in such a complicated field,” said Asad Cheema, MD, medical director, electrophysiology laboratory who performs ablations for correcting arrhythmias at Englewood Hospital. “When you have a team of nurses and doctors that have been together for two decades, everything moves smoothly, everyone knows their roles, and everything runs like a well-oiled machine.”
Catheter ablation cures arrhythmias such as those seen in Wolff-Parkinson-White syndrome or atrioventricular nodal reentrant tachycardia, a type of supraventricular tachycardia. Dr. Cheema and the other physicians in the department often use radiofrequency energy to heat the catheter tip for precise ablation of live heart tissue. The procedure, which has a nearly 100% success rate, is quick and patients leave the same day, only needing to take a short course of aspirin.
Dr. Cheema explained that the laboratories at Englewood Hospital use the most advanced satellite sensors to pinpoint the exact location of catheters and the diseased tissue in the heart, allowing for cure of arrhythmias without risking side effects, such as esophageal damage. “All the latest technology and all the bells and whistles improve outcomes, recovery time and the patient’s prognosis,” he said. “It’s really a great way to treat patients.”
While heat cures arrhythmias, the electrophysiology team—which includes David Feigenblum, MD, PhD, Dmitry Nemirovsky, MD, and Satish Tiyyagura, MD—often also uses cryoablation to freeze heart tissue that causes paroxysmal atrial fibrillation. The surgeons use 3-D mapping to tailor the cryoballoon to variations in left atrial size and pulmonary vein anatomy.
The variety of expertise and experience creates a collaborative atmosphere at Englewood Hospital. “While we have our own teams, we often communicate and share thoughts on tough cases,” Dr. Cheema said. “We’re competing for excellence. We’re not competing against each other.”
Dr. Cheema sees something unique at Englewood Hospital. “We develop wonderful relationships because the hospital environment is friendly and patient oriented. Patients get directed to the right person very quickly.”
Posted September 2017
The use of novel technology in the newly established coronary artery chronic total occlusion (CTO) program at Englewood Hospital and Medical Center is giving many patients a new lease on life.
CTOs are arteries that are 100% blocked for three or more months. They are responsible for clinically significant decreases in blood flow, and they can affect the survival and quality of life of hundreds of thousands of people who have artery blockages. CTOs also are identified in up to 31% of patients referred for coronary angiography.
Now, a procedure called percutaneous coronary intervention (PCI) can successfully treat over 90% of patients with CTOs and improve their quality of life.
While some patients with CTOs are treated with bypass surgery, 60% of them are treated with only prescription drugs. Many of these patients also are told that nothing can be done to open their CTOs using standard angioplasty and that they may end up living with chronic angina. Historically, fewer than 5% of CTOs in the United States have been treated by traditional PCI, but now with novel techniques in use at selected medical centers, including Englewood Hospital, many patients can be effectively treated with PCI.
“Historically, using standard PCI techniques, the success rate was only about 40% to 50%,” said Aron Schwarcz, MD, an interventional cardiologist at Englewood Hospital. “With newer technologies and newer techniques, the success rate at Englewood Hospital exceeds 90%.”
Dr. Schwarcz, along with Richard Goldweit, MD, developed the CTO program at Englewood Hospital in 2015. The program uses a hybrid algorithm to determine which methods would be most effective to achieve a successful PCI outcome. There are three techniques to cross the CTO stenosis: using wires to enter the lesion, using the subintimal space to go around the lesion and reenter the vessel on the other side, or going retrograde past the lesion. Clinicians at Englewood Hospital have treated more than 60 patients since the program began, with nearly all experiencing a lower angina burden and an improved quality of life.
Dr. Schwarcz said clinicians should keep a few things in mind when managing coronary CTOs. First, not all patients have typical angina symptoms. “Patients don’t necessarily get chest pain or chest pressure. Some of our most symptomatic patients had chronic dyspnea on exertion and atypical chest discomfort as their angina,” he said. “You need a detailed history and workup to determine if the dyspnea or other symptoms are an anginal equivalent or from a different cause.”
Second, failing past treatments for CTOs doesn’t preclude an individual from receiving effective treatment with the new procedure.
In May 2015, one of the first patients to enter the CTO program at Englewood Hospital was a 57-year-old, small-business owner who was unable to work or travel due to crippling angina. He had a CTO of the left circumflex artery and had two previous failed attempts to fix the blockage. Physicians at Englewood Hospital treated the patient by opening the CTO using the novel PCI procedure.
“His case really stuck out in my mind. About a week after the procedure, we saw him for follow-up in the office, and he was ecstatic. He was feeling 100% better, and he was able to work at the level that he used to. He had no angina and no limitations,” Dr. Schwarcz said. “This case illustrates the types of patients that we can help and the benefit that we can give them.”
Posted September 2017
