News Stories

Clearing blocked arteries

Tuesday, November 6, 2007 By BETSY QUERNA HERALD NEWS

Jack Goodrich, a retired West Milford cop, can't walk more than one-fourth of a mile. When he tries, or when he walks uphill, severe pains in his legs force him to stop.

His feet often go numb or tingle, a common problem for people like him with diabetes. Sometimes they hurt. Sometimes he loses feeling completely.

His problem, peripheral artery disease, is all too common, especially among senior citizens. It develops over the course of decades, as fatty deposits of plaque build up along the inner walls of blood vessels, often those in the legs. As it progresses, the arteries in the legs become clogged and blood cannot flow to the lower legs and feet.

Goodrich's problem is in his femoral artery, the largest one in the leg. "It's all blocked," he says.

If untreated, peripheral artery disease can become a serious problem. People with the disease are more likely to have blockages in all their blood vessels, putting them at a higher risk for heart attacks or stroke. As the vessels narrow, less blood circulates into the limbs. If arteries become completely blocked, people can develop gangrene or even lose a limb.

Until recently, there wasn't much that could be done for the millions of Americans with peripheral artery disease. Surgeons sometimes did a bypass, where open vessels were run parallel to the blocked arteries, giving blood a detour to get to the lower legs. The surgery was complicated, often lasting six hours or more, and was usually only done in the most severe cases.

Doctors have also tried using stents, the same wire mesh devices used to prop open arteries near the heart, though those also had limited success because many of the blood vessels in the legs are small and the blockages long.

Over the past few years, however, a new type of treatment has been gaining popularity. Atherectomy, in which built-up plaque is shaved off or drilled through using lasers or other new technology, can reopen blocked vessels less invasively than bypass and with more success than stents, doctors say. The procedure could give hope to patients who previously thought leg pain and numbness was just another hazard of old age.

Before atherectomy, "there really has not been a lot of options to revascularize these patients," said David Cohen, an interventional cardiologist at St. Joseph's Regional Medical Center in Paterson.

For the past few years, Cohen has used a device known as a SilverHawk, made by FoxHollow Technologies, a subsidiary of the company ev3. That device chips away at arterial plaque, skimming it off the interior of the artery.

Cohen said, however, that the SilverHawk has a tough time with calcified plaque, which is as nearly as hard as bone and often prevalent in patients with peripheral artery disease. "We deal with very heavy calcium and it makes these plaques like rocks," he said. "You can't get anywhere with existing devices."

Last week, Cohen tried a new device, known as the Diamondback 360°, manufactured by Cardiovascular Systems Inc. and approved by the Food and Drug Administration in August.

The device promises to pulverize calcified plaque into bits smaller than blood cells. It was the first time it had been used in New Jersey. Jack Goodrich was the patient.

Goodrich's arteries were blocked with long calcium deposits, Cohen said. He had two blockages in his right leg, one a whopping 10 millimeters long.

In the morning, as nurses wheeled Goodrich into the catheter lab at St. Joseph's, the plan was to plow through the clogged arteries in the right leg, allowing blood to flow through again and hopefully reducing the pain in his legs and feet.

Finding the source

After inserting a catheter into Goodrich's leg, Cohen shot dye into his blood vessels. A television screen broadcasting images from an X-ray lit up, revealing a spidery line of blood vessels running down the leg. One vessel, Cohen saw, was conspicuously dark. In that vessel, Goodrich's femoral artery, no blood was getting through.

As Cohen prepared to use the Diamondback, snaking a wire down through the vessels that will guide the machine, the doctor leaned up to his patient. "We're getting ready to do the old roto-rooter here," he said.

A whirring sound, like a dentist's drill, signaled the Diamondback was on and moving. It has a diamond-studded tip that rotates and sands through plaque. On the X-ray scan it looked like a small worm snaking down a narrow channel of the man's blood vessels.

When the tip of the Diamondback hit a calcified blockage, the pitch of the sound changed and it stopped. "It's hitting a rock of calcium," Cohen said.

Cohen and Michael Bogart, a representative from Cardiovascular Systems Inc., discussed the rotation speed that would allow it to break through. Bogart adjusted the speed and Cohen moved the tip up and down in the vessel, using a controller outside the body. With several tries, he rammed through. "Once you go through once or twice, it's just like a knife through butter," he said. "This is fabulous." He almost sounded giddy.

Cohen sanded down the artery to Goodrich's knee, opening up a channel to restore the vessel's blood flow. After he removed the device, he again shot dye into the man's leg. This time, the large artery suddenly filled with colored liquid, clearly visible on the X-ray screen. Blood would now be able to flow with that same ease.

Before lunchtime, a blockage that had built up over decades was gone.

Several days later, Goodrich is home but still not moving around much. His right leg "feels a little bit better," he says, though he's still a bit sore from the procedure. Still, he's hoping Cohen will use the Diamondback on his left leg, which is still clogged with solid rocks of plaque. Other attempts to clear that leg haven't worked, he says. "At least this one got through."

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