Hospital Services

Vascular Interventional Services

Coronary Artery and Valvular Procedures
Dr. Donald Durbeck, founding partner of Associated Cardiologists, was the first cardiologist in the area to perform balloon angioplasty. His interest and skill in this leading edge technology blazed the trail in 1987 for cardiology, and cardiac patients in the Central Pennsylvania area. Prior to the initial procedure performed at Polyclinic Medical Center, patients traveled out of the area for the treatment, or underwent open-heart surgery for blockages.

Dr. Michael Bosak now serves as Director of Interventional Medicine for Associated Cardiologists. He and his talented colleagues, Kenneth May, Jr., Robert Aronoff, Andreas Wali, Rajesh Dave and Sang Kim all perform coronary interventions. The procedure involves a small incision in the femoral artery, and the insertion of a catheter through the artery to the heart. A dye is infused, and the arteries around the heart are visualized by fluoroscopy. Blockages found may be cleared with angioplasty, and a stent may be placed to secure the open pathway through the artery.

Cardiac Catheterization
A doctor inserts a thin plastic tube (catheter) into an artery or vein in the arm or leg. From there it can be advanced into the chambers of the heart or into the coronary arteries. This test can measure blood pressure within the heart and how much oxygen is in the blood. It is also used to get information about the pumping ability of the heart muscle. Catheters are also used to inject dye into the coronary arteries. This is called coronary angiography or coronary arteriography. Catheters with a balloon on the tip are used in the procedure called percutaneous transluminal coronary angioplasty.

Stent Procedure
A stent is a wire mesh tube used to keep open an artery during angioplasty. The stent is collapsed to a small diameter and put over a balloon catheter. It is then moved into the area of the blockage. When the balloon is inflated, the stent expands, locks in place and forms a scaffold. This holds the artery open. The stent stays in the artery permanently, holds it open, improves blood flow to the heart muscle, and relieves symptoms (usually chest pain).

Stents are used depending on certain features of the artery blockage. This includes the size of the artery and where the blockage is. Stenting is a common procedure; in fact, it now represents 70-90 percent of procedures.

In certain patients, stents reduce the renarrowing that occurs after balloon angioplasty or other procedures that use catheters. Stents also help restore normal blood flow and keep an artery open if it has been torn or injured by the balloon catheter. Reclosure (restenosis) is also a problem with the stent procedure. In recent years, doctors have used new types of stents called drug-eluting stents. These are coated with drugs that are slowly released and help keep the blood vessel from reoccluding. These newer drug eluting stents have shown promise for improving the long-term success of this procedure.

Patients who have had a stent procedure must take one or more blood-thinning agents. Examples are aspirin and clopidogrel. Aspirin is used indefinitely; clopidogrel is used for one or more months (depending on the type of stent) after the procedure. Clopidogrel can cause side effects, so blood tests will be done often. If you are taking this medication, it is important that you do not stop taking it without consulting your doctor. For the next four weeks, a magnetic resonance imaging (MRI) scan should not be done without a cardiologist's approval. However, metal detectors do not affect the stent. To date there is no evidence of long-term complications from having a permanent stent.

Percutaneous Coronary Interventions
(previously called Angioplasty)
Percutaneous coronary intervention (PCI) encompasses a variety of procedures used to treat patients with diseased arteries of the heart, for example, chest pain caused by a build-up of fats, cholesterol, and other substances from the blood (referred to as plaque) that can reduce blood flow to a near trickle, or a heart attack caused by a large blood clot that completely blocks the artery.

Typically, PCI is performed by threading a slender balloon-tipped tube - a catheter - from an artery in the groin to a trouble spot in an artery of the heart (this is referred to as percutaneous transluminal coronary angioplasty - also known as PTCA, coronary artery balloon dilation or balloon angioplasty). The balloon is then inflated, compressing the plaque and dilating (widening) the narrowed coronary artery so that blood can flow more easily. This is often accompanied by inserting an expandable metal stent. Stents are wire mesh tubes used to prop open arteries after PTCA.

Intravascular ultrasound (IVUS)
Intravascular ultrasound (IVUS) is a catheter-based technique, which provides real-time high-resolution images allowing precise tomographic assessment of lumen area, plaque size, and composition of a coronary segment, and therefore provides new insights into the diagnosis of and therapy for coronary disease. The arteries of the heart (the coronary arteries) have been the most frequent imaging target. IVUS is used in the coronary arteries to determine the amount of disease at any particular point in one of the coronary arteries regardless the presence or absence of any stenosis. Additionally, IVUS also shows a much more accurate measurement of the degree of stenosis of the opening of the coronary arteries than possible with angiography.

Valvuloplasty
It is used to widen a stiff or narrowed heart valve (stenotic heart valve). A catheter is guided through the heart and positioned through the diseased heart valve. Balloons on the catheter are inflated, enlarging the opening through the valve and improving blood flow through the heart and to the rest of the body. This allows the heart to pump more effectively, reduces pressures in the heart and lungs, and reduces symptoms.

Patent Foramen Ovale (PFO) Closure
A cardiac catheterization involves slowly moving a catheter (a long, thin, flexible, hollow tube) into the heart. The catheter is initially inserted into a large vein through a small incision made usually in the inner thigh (groin area) and then is advanced into the heart. One or more tests will be done to measure the PFO and to be sure there are no other defects. An imaging test called angiography, (an injection of a certain type of dye followed by an x-ray motion picture) may be used to better visualize the heart. An ultrasound imaging technique, to see the defect better and to determine the size of the closure device needed, may be used. One technique, intracardiac echo (ICE), involves passing an imaging device up to the heart through the vein in the patient's other leg. Another technique uses an ultrasound probe passed down the esophagus (transesophageal echo, or TEE) to allow your doctor to see the heart structures and blood flow as the device is being placed. In addition, a special balloon on a catheter is moved to the area of the hole and inflated across the hole in order to measure the size of the hole when it is gently stretched.

A PFO closure device is moved through the catheter to the heart and specifically to the location of the heart wall defect. Once in the correct location, the PFO closure device is allowed to expand its shape to straddle each side of the hole. The device will remain in the heart permanently to stop the abnormal flow of blood between the two atria chambers of the heart. The catheter is then removed and the procedure is complete.