West Suburban Cardiologists, Ltd (Chicago)

Invasive Cardiology

Diagnostic and Therapeutic Cardiovascular Procedures

Our Non-Invasive Vascular Imaging Lab is Accredited

Most patients who come to the Cardiac Catheterization Lab are referred for an 'Angiogram' or 'Cardiac Cath'. These Invasive cardiac procedures are performed in patients with symptoms or signs suggestive of coronary artery disease, valvular heart disease- including Aortic Stenosis, and other heart ailments. Patients with these symptoms often report chest tightness or discomfort or shortness of breath and have frequently had an abnormal echocardiogram or stress test as part of their early cardiac evaluation. For patients with resting symptoms or increasing chest pain or breathlessness, particularly that which occurs at rest, cardiac catheterization is usually performed as the first diagnostic test. The test also identifies patients with congenital heart disease and coronary anomalies.

Most patients with cardiac chest pain or 'Angina' have blockages in their heart arteries. The blockage is often composed of different materials but predominantly consists of calcium and cholesterol rich plaques that narrow the internal diameter (or lumen) of the artery. Most significant blockages narrow the artery by at least 60-70%. Cholesterol lowering medications help reduce the build-up of these plaques and in some cases can cause regression of the blockages. Read about Emergency Heart Attack Treatment and Unstable Angina.

Unfortunately, there is no cure for coronary disease. Blockages can be treated successfully with medical therapy, angioplasty, open heart or bypass surgery, or a combination of the above. In patients with coronary artery disease (blocked heart arteries), an Interventional or Revascularization procedure may be performed in the cath lab. These are therapeutic or 'Interventional' procedures and are often referred to as 'Angioplasty' or PTCA. Angioplasty is a non-surgical treatment for blocked arteries. This procedure is often performed at the same sitting as the diagnostic angiogram under light-moderate sedation. Angioplasty is our preferred treatment modality for acute heart attacks.

Most interventional procedures involve opening a blockage with a balloon catheter and then insertion of a metal device called a Stent. Stents are generally made of stainless steel and are permanently inserted into the artery. Stents increase the safety of these procedures and improve their long term success. They work by providing a scaffold which props the artery open. Other techniques, such as the use of Rotational Atherectomy, attempt to remove the blockage. Rotational atherectomy is similar to a dentist drill. It is a burr shaped device that spins at 160-200,000 RPM. It works by grinding or ablating the plaque. All of these techniques have their pros and cons. Major complications are infrequent. However, the likelihood of the blockage returning over a 6-8 month period is roughly 20-40% with approximately 20% of patients requiring an additional angioplasty or stent procedure during that same time period. When the blockage recurs over this short time frame, it is generally related to the healing process in a process termed Restenosis as opposed to new plaque formation.

West Suburban Cardiologists perform 1st Brachytherapy Treatment for Stent Restenosis at Hinsdale Hospital
Drs. Duane Follman and Frank Saltiel (pictured here) treat a patient with stent restenosis. West Suburban Cardiologists working at Hinsdale Hospital can now offer 'Brachytherapy' or intravascular radiation therapy to treat restenosis. Stent restenosis occurs after 10-25% of stent procedures and involves an intense healing process that re-narrows previously treated arteries- usually within 6 months. In essence, scar forms within the stent which then re-clogs the artery. Treatment of stent restenosis remains a problem. Brachytherapy offers new hope in treating this difficult problem. By inhibiting cell growth within the stent, brachytherapy turns off the scarring process preventing it from significantly reclogging the artery.

Hinsdale Hospital is the first hospital in the Chicagoland area that was not involved in the initial clinical trials of radiation therapy to offer this important new therapy. The Hinsdale cath lab uses the Galileo system by Guidant to perform intravascular radiation. The procedure is similar to angioplasty and done through a small tube placed in the groin. Most patients return home the following morning. This same system will soon be available at LaGrange hospital as well.

Read about ways to prevent contrast induced kidney failure.

We also perform procedures to treat other forms of heart disease including palliative Balloon Aortic Valvuloplasty for symptomatic patients with Aortic Stenosis. Aortic Valvuloplasty is generally not offered to patients who are candidates for surgery to replace the aortic valve because it does not provide the same type of long lasting benefits seen with surgery. It is a reasonable procedure though for carefully selected patients who are significantly limited by aortic stenosis.

At West Suburban Cardiologists, we have several physicians who specialize in Invasive Cardiology and catheter treatment of coronary artery disease. Three physicians, Drs. Carell, Cohen, and Levin also specialize in catheter treatment of peripheral vascular disease.

Useful Invasive Cardiology Links
Journal of Invasive Cardiology
PTCA.org
Society for Cardiac Angiography and Intervention
Radial Cath

At West Suburban Cardiologists, we also have a strong interest in the evaluation and treatment of patients with Peripheral Vascular Disease or 'PVD'. PVD has the same risk factors as coronary artery disease (smoking, high blood pressure, high cholesterol, diabetes). Many of our patients with angina also have symptoms of PVD such as intermittent claudication or painful walking. Claudication often occurs in patients with blockages in the arteries of the thigh or legs and can prevent some patients from walking more than a block or two without having to stop because of burning or pain in the large muscles of the thigh or lower legs. Other patients may have peripheral vascular disease affecting other vascular territories such as the renal (kidney) arteries, carotid or subclavian arteries or even the aorta itself. All of these territories may be amenable to catheter treatment with balloon angioplasty or stents. Patients with difficult to control high blood pressure are frequently discovered to have Renal Artery Stenosis which can often be treated quite successfully with renal artery stenting.

View a Slide Presentation on PVD