By Radoslaw S. Kiesz, MD
We have a unique and challenging patient population in San Antonio. The prevalence of diabetes, heart disease and peripheral vascular disease in central Texas is staggering. Much is demanded of physicians in the area. In the past decade, new devices and percutaneous techniques have been developed and refined to treat vascular disease from the head (carotid) to toe (dorsalis pedis).
San Antonio has a rich history of innovation in the vascular arena. Dr. Julio Palmaz developed the stent at University of Texas Health Science Center at San Antonio in the late 1980s. In the early 1990s, carotid stenting was pioneered by interventional cardiologists at UTHSCSA.
I performed one of the first five cases of carotid stenting in the U.S. The experience of our local operators who assisted the development of carotid stenting continues to be a major asset to our local patients. We hope to offer patients at risk of devastating stroke some hope in the form of treatment options by way of carotid and vertebral artery stenting.
The first carotid stent was FDA-ap-proved in August 2004. Today, physicians in private practice who have com-pleted specialized training are able to perform the procedure. Interventional cardiologists here in San Antonio serve as top level investigators for several carotid stenting studies (CAPTURE, CAPTURE 2 and EXACT). I am honored and proud be at the forefront of carotid stenting, having enrolled the largest number of patients in the CAPTURE study for a single-operator-center in the U.S. The results of this study have been presented at national and international levels. Gradually, we will be able to offer our patients who have more complex diagnoses more treatment options for this often difficult to treat disease.
Vertebral artery stenosis also is a major cause of stroke. Unfortunately, this condition is largely underdiagnosed and undertreated. We have pioneered treatment and created a patient registry, with our outcomes published in The Journal of the American College of Cardiology,
presented at the Annual Scientific Sessions of the American College of Cardiology in 2004 and presented at the Paris Course for Revascularization in 2006.
In several cases, emergent percutaneous transcathether angioplasty (PTA) and stenting were used to treat stroke in the posterior distribution caused by sudden occlusion of the vertebral artery. All of our acute patients treated with vertebral stenting completely recovered within the next 12 hours. One patient in particular removed his own tracheotomy tube, percutaneous endoscopic gastrostomy (PEG) tube and walked out of hospital, albeit against medical advice.
In San Antonio, cardiovascular disease is rampant. The complexity of coronary artery disease (CAD) cases seen in San Antonio and surrounding areas is second only to diabetes and often end-stage renal disease (ESRD).
My excellent colleagues in San Antonio and I have pioneered percutaneous techniques to offer our complex patients more treatment options. Currently, I am operating under an IRB-approved and internationally adopted protocol for percutaneously treating three-vessel coronary artery disease, as well as disease of the left main coronary artery. All patients enrolled under the protocol to date have received complete three vessel revascularization from a single setting operation.
For our patients with renal dysfunction and ESRD, we have worked to develop effective new treatment options. We have published our renal stenting registry experience in Catheterization & Cardiovascular Interventions. This study has shown significant improvement in BUN and creatinine post renal stenting in patients with renal dysfunction.
A great threat to our patients’ longevity, especially here in San Antonio, continues to be peripheral arterial disease (PAD). This underdiagnosed and undertreated systemic disease leads to much suffering by way of decreased activity, decreased quality of life, depression, claudication, ischemic ulcerations, gangrene, amputations and worse.
We continue to pioneer new treatment options such as plaque excision atherectomy and chronic total occlusion crossing devices for the treatment of peripheral arterial disease.
Having pioneered the development of plaque excision atherectomy in Europe and North America, I performed the first below the knee plaque excision in the world. The patient was scheduled for an above knee amputation, and after percutaneous revascularization with plaque excision; the patient is still walking on his own two legs today (three years later). Our outcomes and data on limb salvage from amputation have been published and presented nationally and internationally.
In September 2006, I performed the first-in-man Optical Coherence Tomo-graphy (OCT) guided plaque excision atherectomy. This new combined ima-gining and interventional catheter im-proves patient safety by allowing the physician to “see” where he or she is and what he or she is doing.
In my research, I have developed percutaneous treatment options in every vascular bed including, but not limited to, the mesenteric, celiac trunk and middle cerebral arteries.
While there is much research left to do, the field of vascular disease treatment is more promising than ever, offering patients dramatic new options for their health and survival.
