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Cardiac, vascular care advances

June 18, 2007|by TIFFANY ARNOLD

Wilmer "Gene" Vandegriff knew nothing of the growing blockage in his carotid artery - the artery that carries blood to his head and neck.

Except for two bouts of numbness: When he was driving, the entire side of his body went numb for about two minutes. It happened again while he was sitting at home in a lounge chair.

He didn't think the numbness was a big deal until after a routine screening in April, when doctors determined that there was a blockage, which meant Vandegriff was at risk of having a stroke.

"I thought, well, if my carotid is blocked, I'm either a stroke or a heart attack waiting to happen," said Vandegriff, 67, of Fairfield, Pa.

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Vandegriff's condition is easily treatable thanks to a procedure now available at Washington County Hospital. Surgeons insert a stent - a tube that holds arteries open - into Vandegriff's blocked artery.

Soon, the hospital will offer more treatments for patients in need of cardiac and vascular care. The options should benefit patients who suffer acute heart attacks and might have otherwise been sent to hospitals in the Baltimore or Washington D.C., areas.

The hospital has received approval for two heart and vascular procedures: One for patients with a blocked carotid artery; and another that enables surgeons to implant a stent in arteries of the heart for those suffering from an acute heart attack, a procedure known as primary percutaneous coronary intervention (PPCI).

Though the hospital received approval to do PPCIs in March, hospital officials said the procedure won't be offered until January 2008, after more people are hired and another diagnostic lab is built.

The hospital also has been named a Primary Stroke Care Center. When the designation goes into effect in September, the hospital will become one of 20 hospitals in Maryland that are go-to facilities for medics transporting stroke victims.

Combined, the advances mean better care for patients, doctors and hospital officials said.




Less-invasive procedure to prevent stroke

In March, Vandegriff became the first Washington County Hospital patient to receive a carotid stent, which is a tubular device inserted into the carotid artery to keep the blood vessel open.

The U.S. Food and Drug Administration approved the first carotid stent system in 2004. Studies found it successfully opened blockages in 92 percent of 581 patients who received the device, according to FDA press materials.

Before, fixing the problem would have meant dissecting Vandegriff's carotid artery in order to remove the clot. It also would have taken longer for Vandegriff to recover - one to two weeks, versus one to two days - said vascular specialist Dr. William Su, one of the surgeons who inserted Vandegriff's stent.

Had Vandegriff come to the hospital a year earlier, he likely would have been sent to Johns Hopkins Hospital, Su said.

Washington County Hospital received approval from Centers for Medicare & Medicaid Services - a branch of the U.S. Department of Health & Human Services - to do the procedure in December 2006, said Cathy Ware, the hospital's vascular care specialist.

Su said that not everybody is eligible for this procedure due to certain medical conditions. He estimated that roughly 5 to 10 percent of all those with blocked carotid arteries would be eligible for this procedure.

Primary Stroke Care Center designation

Washington County Hospital has been named as a Primary Stroke Care Center, one of 20 Maryland hospitals to be designated as go-to facilities for medics bringing in stroke victims.

The designation - part of a new statewide initiative - is official Sept. 1.

It means that people who are showing symptoms of a stroke and have called 911 within three hours of those symptoms appearing will be sent to Washington County Hospital - or the Primary Stroke Care Center nearest them.

"That means if you have two hospitals across the street from each other and one has the designation and the other one doesn't, the one with the designation will get preference," said John Young, director of Hospitals for the Maryland Institute for Emergency Medical Services.

The Maryland Institute for Emergency Medical Services Systems (MIEMSS) is the agency responsible for naming stroke care centers. The independent state agency oversees all aspects of emergency medical services in Maryland.

Before the designation program was initiated, such patients would have been sent to the hospital closest to them, Young said.

While those hospitals likely would have been able to treat such patients, improving logistics for emergency medical services (EMS) ultimately translates to better care for stroke patients, Young said.

"Those three hours are critical," Young said. "The only FDA-approved medicine for stroke is only authorized to be used within three hours of the first symptom."

Young was referring to a clot-busting drug known as tissue plasminogen activator (or tPA). Studies suggest tPA reduces the amount of damage to the heart muscle.

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