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2.10.2017

Stroke Stent-Retriever Device Saves Patient with Blocked Coronary Artery

The history of medicine is filled with instances when a technique commonly used for one procedure is tried for something very different — and it works, opening up a whole new range of clinical possibilities for future patients.

This occurred last March, when a heart attack patient with a large clot blocking his left main artery arrived at Jackson Memorial Hospital. Cesar E. Mendoza, M.D., interventional cardiologist and director of the Cardiac Catheterization Laboratory at Jackson, made multiple unsuccessful attempts to restore blood flow using conventional balloon angioplasty. The next step would have been to open up the patient’s chest, but his other health factors made that invasive surgery a high-risk procedure.

Then Mendoza remembered that a colleague, Dileep R. Yavagal, M.D., associate professor of clinical neurology and neurosurgery, chief of interventional neurology and co-director of endovascular neurological surgery at the University of Miami Miller School of Medicine, had reported success capturing and removing the clots of stroke patients using a stent-retriever device. He called in Yavagal to attempt the same technique on his heart attack patient — something that had never been tried before.

In a 60-minute procedure, Yavagal used the approved stroke thrombectomy stent-retriever — the Solitaire FR, made by Medtronic — to remove the clot, saving the patient’s life. The complete blood flow to the heart supplied by the artery was fully restored, and the patient’s condition improved immediately after the procedure. The procedure did not cause any adverse effect, such as injury to the heart artery or displacement of the clot fragments to other organs.

An article describing the procedure was published on February 6 in JACC (Journal of the American College of Cardiology) Interventions. Yavagal (corresponding author) and Mendoza (senior author) were joined by co-authors Nish Patel, M.D., a cardiology fellow, and Amit Badiye, M.D., assistant professor of medicine.

“The stent-retriever device has the advantage of being able to remove the clot, or thrombus, blocking an artery rather than just pushing the clot aside like the angioplasty procedure does,” said Yavagal. “Although this is a single successful case of using the stroke stent-retriever device to open a blocked coronary artery that would not open with conventional cardiology devices, I am quite excited about the possibilities of testing this approach further to see if it improves upon the current devices used in patients with heart attacks. Our approach capitalizes on the cross-fertilization between different specialists at UM to push the envelope to improve patient outcomes.”

“This case demonstrates that teamwork and close cooperation between different specialties can lead to innovation and to the development of new strategies to treat patients with life-threatening heart conditions,” said Mendoza. “Certainly, this technology opens a new path in the field of coronary intervention and may reshape the future practice of opening heart arteries blocked with harmful blood clots.”

The next step, said the authors, is to perform a safety study, with FDA approval for research, to prove consistent application and safety of the procedure in a small number of patients. Further success could lead to a larger clinical trial.

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