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DMC cardiologist pioneers system to treat pulmonary embolisms

Originally Published in Crain’s Detroit Business, January 15, 2017

Thousands of people have died over the years from what originally was believed to be a heart attack when the actual cause was a massive pulmonary embolism, said Mahir Elder, M.D., a top interventional cardiologist at Detroit Medical Center‘s Cardiovascular Institute who has developed a new diagnostic check for these serious kinds of emergency cases.

In the nation’s largest study of its kind, Elder and his Pulmonary Embolism Response Team (PERT) — also called the Clotbusters — have treated more than 250 patients the past two years for massive pulmonary embolisms with a lifesaving rate greater than 90 percent, far higher than the 42 percent save rate documented in other studies where patients received the blood-thinning drugs tPA or heparin.

“It started when I noticed a few cases in the (Detroit Receiving Hospital) ER back in 2012,” said Elder, who also is assistant director of the Wayne State University School of Medicine’s interventional cardiology fellowship program.

“PE can often be masked as MI (myocardial infarction, or heart attack),” said Elder. 
“It is often misdiagnosed, which can result in an unfortunate mortality. It is completely preventable if discovered promptly.”

Many ER physicians and other specialists don’t immediately diagnose the blood clot in the lung that is causing the emergency.

“A patient presents to the ED with difficulty breathing, short of breath and sharp chest pain, requiring oxygen therapy with low blood pressure (80/40 or less),” said Elder, a former Crain’s Health Care Hero.

“This requires quick action. Before, there was no standard way to treat it. No research, no procedure.”

Elder said reviews of national registries of unexplained deaths have shown that thousands of deaths were caused by massive pulmonary embolisms. This most usually happens when a blood clot dislodges from the leg and travels up into the lungs, blocking blood flow. This progresses to cardiac arrest, or a heart attack.
Each year, pulmonary embolisms kill at least 600,000 Americans, many of whom had no or little symptoms. It is one of the leading causes of sudden death.

In 2014, Elder received institutional review board approval from the Wayne State medical school and the DMC. His boss, Theodore Schreiber, M.D., president of the DMC Heart Hospital, was supportive of his plan to create the PERT team and institute the special PE guidelines in DMC Receiving’s emergency department. Schreiber is also on the PERT team.

“ER doctors will perform a cardiac ultrasound or CT scan of the lungs to confirm diagnosis (of PE). Once confirmed, the PERT team is activated,” said Elder, adding that the patient is then transferred to DMC’s catheterization lab at the Heart Hospital for an emergency procedure.

Elder, who is one of Michigan’s highest-volume operators of peripheral arterial disease and amputation prevention, said the approval process for PE guidelines was not easy.

“The naysayers (initially ER physicians, pulmonologists, vascular surgeons and interventional radiologists) were concerned that it may not work and there could be other options,” said Elder, who also is medical director of DMC Harper Hospital‘s cardiac care unit. “We won them over because we were saving lives. The ER doctors are very proud of what we did.”

The first step Elder needed was to develop the massive/submassive pulmonary embolism guidelines for the ER physicians to use in screening patients. The procedure algorithm is multifaceted, but begins with an initial patient evaluation. The guidelines recommend the patient be given 15 minutes of CPR.

For example, the patient presents with chest pains and other heart attack-like symptoms. ER doctors then order an IV, cardiac monitor and EKG, appropriate blood tests, CT angiogram or echocardiogram of the chest and heparin.
If the CT scan confirms symptoms of PE, ER doctors page a PERT team member and the patient is sent to the cath lab for an immediate procedure. DMC’s PERT team includes five interventional cardiologists, several fellows, nurses, cardiovascular technologists and radiology therapists.

Once the patient is in the cath lab and the PERT team is ready, Elder or another team cardiologist inserts a thin plastic tube (catheter) through a large vein in the patient’s groin area. The catheter tube is maneuvered through the patient’s circulatory system and deep inside the pulmonary artery close to the blood clot. Once in place, cardiologists break up the coagulated blood with ultrasound and inject anticlot medications.

“The procedure takes about 30 minutes and we are done,” Elder said. “It takes another four to six hours, depending on the size of the clot, to dissolve it.”
Technologies used for the procedure, known in the medical field as catheter-directed thrombolysis, were developed for other heart- and artery-related procedures. Elder’s team uses the EKOS Acoustic Pulse device.

“We use EKOS ultrasound to break up the fibrin clot, which is a web of strands that are connected together. Simultaneously, we use the anticlotting medication to dissolve it,” he said. The EKOS technology allows Elder and team to use much less blood thinner, which makes the procedure safer.

Under some extreme circumstances for highly unstable patients, Elder said, a small pump, the Abiomed Impella RP, is used to keep the heart going. “It is a temporary pump that decreases the pressure on the heart and offers circulatory support,” he said. “It is removed once the patient is stable.”

At first, Elder’s PERT team received referrals from DMC’s ER physicians and from the co-located Karmanos Cancer Institute.

“Now, pulmonologists, oncologists and surgeons with patients who develop PEs are seeing the benefit in our program” 24/7, Elder said.

Elder said DMC now has received referrals from several hospitals in Michigan, including patients who are airlifted from around the state.

Soon after Elder began researching options with PE, he discovered cardiologists at Massachusetts General Hospital were starting a similar program, and he called them to discuss options. He found they did not have a standard procedure. Since then, Massachusetts General has formed a national PERT consortium, which DMC has joined, to help spread the word at hospitals and with doctors.

To be successful, Elder said PERT teams must be inclusive and collaborative. They also must be able to quickly respond to PE cases. Mortality rates rise quickly as time passes, he said.

“We are ahead of Mass General. They have a team but not as efficient as us because we are in-house and open 24 hours a day, seven days a week, 365 days a year. They have a meeting first, then call in the team. It takes too long,” Elder said.

“Our hospital is the nation’s highest enroller in PE clinical research. We get more patients into the cath lab than anyone because we are here 24/7” through DMC’s Cardio Team One, he said.

Elder said having the PERT staff on call 24/7 is expensive, but after several years the service is now profitable. “You need at least 50 cases per year to be proficient,” he said.

But Elder said the ability to save lives makes it worthwhile for his team and the hospital.

“You should see them when they come into the ER. They are in very poor condition. They can’t breathe on their own and have a tremendous amount of chest pain. After the procedure, they are comfortable and they walk out of the hospital,” Elder said.
The majority of patients treated at DMC understand the importance of taking care of their health, Elder said. They hydrate, exercise and make sure they don’t sit too long without some form of movement, he said.

“About 90 percent of our patients make changes in their behavior, which significantly reduces the recurrence rates,” Elder said.

Physicians and nurses involved in the program are proud of what DMC Heart Hospital and Cardiovascular Institute are doing to prevent unnecessary deaths, he said.

“We treat massive PE better in Detroit than anywhere in the country,” Elder said. “We can say we are a world authority. We can say we are at the top in innovation and treatment for massive PE. We are proud of that.”

Benefiting from Pulmonary Embolism Response Teams

Written by Chris Cole | Physician’s Weekly | November 30, 2016

Patients with massive or sub-massive pulmonary embolisms (PEs) often face poor survival odds—not necessarily due to the severity of their disease, but because their treatment is often suboptimal or treated too conservatively. This patient population is critically ill but often misdiagnosed as having acute myocardial infarction (MI). These factors may contribute to PE being one of the most common causes of death in the United States.

In order to reverse high mortality rates associated with PE, the Detroit Medical Center created a PE Response Team (PERT) in 2014. The team was designed to treat PE patients as quickly as possible using advanced modalities, including ultrasound-accelerated, catheter-directed thrombolysis. For a study published in Cath Lab Digest, Mahir Elder, MD, and colleagues assessed more than 1,500 cases of patients hospitalized with acute PE.

“We found that patients who were treated with standard systemic thrombolysis had higher in-hospital mortality and intracranial hemorrhage than those who were treated with catheter-directed thrombolysis,” says Dr. Elder.

“To date, the 250 patients who have been treated by our PERT team—called Clotbusters—have a 10% mortality rate, whereas patients at our institution with massive or sub-massive PE who received systemic tPA or heparin have a 60% mortality rate.”

All About PERT 
The Detroit Medical Center PERT includes interventional cardiologists, nurses, cardiovascular technologists, and radiation therapists. Initially, referrals to Clotbusters came from emergency physicians with hypotensive patients who needed immediate treatment.

“Now, pulmonologists, oncologists, and surgeons with ICU patients who develop PEs activate the pager that mobilizes our team 24 hours per day, 7 days per week,” said Dr. Elder.

“We also get referrals from many emergency departments in southeastern Michigan; a radio ad we aired to inform the public about the warning signs of PE also spread the word that we have the expertise and resources to treat these patients.”

Dr. Elder hopes that PERTs eventually will become standard for the treatment of PE. However, before creating a PERT, three essential elements must be in place:

  • The multispecialty team has to be inclusive and collaborative. “At one hospital, interventional radiologists saw the PERT as encroaching on their turf and they refused to participate, which killed the program,” Dr. Elder explains.
  • Operators must have theskill and clinical judgment to treat hemodynamically unstable patients.Such experience comes from having performed at least 50 successful cases.
  • Staff needs a protocolin place so that all equipment is on standby, saving valuable time.


Making a Difference

Clotbusters follows patients after their clots have resolved, educating them on the importance of hydration, exercise, and what to do during prolonged periods of sitting.

“About 90% of our patients make changes in their behavior, which significantly reduces the recurrence rates,” adds Dr. Elder.

“Many physicians treating patients with massive or sub-massive PE aren’t yet aware of the aggressive and effective advanced technologies to treat these critically ill, unstable patients. Clotbusters is a viable option to significantly improve outcomes for patients with PE. Our goal is to reach every patient with PE who needs life-saving treatment.”

Heart Hospital Team Completes Complex High-Risk Procedure Course Via Live Feed

The DMC Heart Hospital recently completed a Complex Percutaneous Intervention education course, utilizing an unprecedented four live, clinically complex cases.

Heart Hospital Team Completes Complex High-Risk Procedure Course Via Live Feed

Participating physicians (pictured at left) included DMC Heart Hospital President Dr. Theodore Schreiber, Vice President Dr. Cindy Grines, Medical Director of the Cardiac Care Unit and Chief of Cardiology Dr. Mahir Elder, Cardiac Catheterization Lab Medical Director Dr. Amir Kaki, and Dr. Tamam Mohamad, all supported by the expert team of clinicians and technicians of DMC Heart Hospital. The Complete Revascularization of Higher Risk Patients (frequently abbreviated as “CHIP”) program helps educate physicians on advanced treatment of left main disease, chronic total occlusions, long lesions, bifurcation lesions, “small vessels,” and saphenous vein grafts. In addition, participants learn how to manage challenging patient groups, such as those with advanced heart failure.

DMC provided four live complex cases; traditionally, most only do one or two live cases. The cases are displayed via live video feed from the cardiac catheterization lab to the education room. This course educated interventional physicians on an option for patients that are too sick for surgery or refuse surgery. Offering advanced educational courses like these helps move DMC toward a “Top 15 Hospital” level, by increasing our reputation among expert physicians across the nation. It increases our own clinical excellence by extending our level of effective care to more advanced heart failure patients.

Dr. Amir Kaki Featured in Roxwood Medical Newsletter

As our first Case of the Month for 2016, we are pleased to feature a case recently completed by Dr. Cindy Grines and Dr. Amir Kaki of Detroit Medical Center.

Case Presentation

A 53-year old male showed symptoms of continued class 3 chest pain and positive stress test with a diagnostic angiography that showed an RCA with chronic total occlusion. Angiography revealed a mid-RCA 100% occlusion with TIMI 0 flow with no retrograde collateral filling.

“The anchored backup of CenterCross coupled with the support and trackability of Micro14 provide significantly greater control when treating complex CTO lesions. These devices have become a core part of our CTO toolkit since they were introduced last year.”

— Dr. Amir Kaki

The CenterCross and Micro14 catheters were used in tandem to provide support to successfully access and cross the RCA total occlusion using a Pilot 200 guidewire. This was followed by a 0.9mm laser (Spectranetics) over an Ironman guidewire to open up a channel, followed by two overlapping 2.5mm x 38mm Xience stents (Abbott) from distal to mid-RCA. Final angiography showed a reduction of stenosis from 100% to 0% to fully restore flow to the RCA.

Close to Death, Lung Clot Patient Survived After High-Tech "Catheterization" at DMC

Detroit – Her name is Barbara (“Barb”) Rhodes, but to hundreds of people in the St. Clair County town of Capac (near Port Huron), she is known simply as “the cake lady.”
A highly skilled cake decorator who spent 44 years bringing joy to people at weddings and birthday parties before her recent retirement, Barb Rhodes is also a vigorously energetic wife and mother who often volunteers as a leader of local Girl Scouts and 4-H Clubs. 

But all of that began to change in the winter and spring of 2014, as the tireless cake lady (now 70) slowly ran out of energy and then found it increasingly difficult to breathe.

By May of 2015, in fact, she was frequently exhausted.  And when she couldn’t even get out of bed anymore – except to drag herself to the dinner table with superhuman effort – her husband Walter realized that something had to be done.

“We were sitting at dinner one night, and I looked at Wally,” she would remember later, “and I said to him: ‘I think I might be dying.’

“And he got right out of his chair.  He said, ‘Let’s get in the truck, honey.  We’re going to the hospital – right now!’”

At the hospital emergency department in Port Huron, the treating cardiologist ran a battery of tests, including a “CAT-scan” imaging procedure designed to look at her heart and lungs.  The tests resulted in a disturbing finding: Barbara Rhodes was in the middle of a “pulmonary embolism,” or “PE.” 

This is an extremely dangerous medical condition in which a large blood clot breaks free from an extremity (usually a leg artery) and then travels through the circulatory system before settling in the lungs.

Because the lung clot often interrupts the flow of oxygenated blood, this condition is regarded as life-threatening . . . and more than half of those patients with severe PE die before they can reach a hospital, according to the latest medical research.

As soon as the Port Huron doctors diagnosed Barb’s PE, they called for an ambulance that would rush her to the DMC Heart Hospital – the only healthcare facility in Michigan with a program already in place to specifically treat pulmonary embolism.

“I was awake on that ride, and I can tell you that we got there in slightly under 45 minutes,” says Ms. Rhodes today.  “We were really barreling!  And I was scared.  I was absolutely terrified.  I kept wondering: is this really the end of my life?”

At the DMC Heart Hospital, meanwhile, the specialized team of PE clinicians was already preparing for the struggle that lay ahead.

Created about two years ago, the DMC’s specialized PE team is led by its founder – Mahir D. Elder, M.D., the senior cardiovascular specialist who directs the Heart Hospital’s Cardiac Care Unit.

Dr. Elder and his fellow blood clot specialists have successfully completed thousands of high-tech procedures for patients with arterial blockages in recent years.  A nationally recognized pioneer, Dr. Elder was the first Michigan heart doctor to build a pulmonary embolism treatment program for high-risk, critically ill PE patients.

Within an hour of reaching the Heart Hospital on the DMC campus in midtown Detroit, Barb Rhodes was being wheeled toward the Catheterization Laboratory, where she would undergo a high-tech procedure to remove the lung clot and restore her normal breathing.

“I remember when they rolled me into the lab, how bright it was in there,” she recalls.  “It was like being in a football stadium for a night game.  I was pretty scared.  But then Dr. Elder took both of my hands and said: ‘Don’t worry, Barb – I’m going to take good care of you.’  And I calmed down right away.”

During the next hour or so, the patient underwent a mostly painless procedure in which Dr. Elder and his team inserted a narrow plastic tube (the “catheter”) into her femoral artery through a tiny incision in her thigh.  Then they maneuvered the tube through her circulatory system until it was positioned adjacent to the life-threatening lung clot.
With the cath tube now in place, Dr. Elder was able to apply state- of-the-art ultrasound and thrombolysis clot-busting technology – along with a series of specially designed medications – to break up and disperse the clot.

According to the 44-year-old Dr. Elder, who was recently named a “Healthcare Hero” by Crain’s Detroit Business for using his catheterization techniques to prevent more than 1,000 needless limb-amputations in diabetes patients, the hour-long catheterization “worked perfectly to remove the clot and restore the patient’s oxygen levels.”  Within a few hours, the relieved patient’s vital signs were almost back to normal and she was no longer in danger of a fatal heart attack.

“I started feeling better almost as soon as they finished the procedure,” she says today.  “My blood pressure went back to normal and I was breathing much easier.”

After being discharged from the DMC Heart Hospital a couple of days later, Ms. Rhodes returned to her home in Capac… and to her husband of 51 years.  She also returned, of course, to Abby and Rose, her two jet-black felines… and to her two grandchildren and four great-grandchildren.

“My energy is back to 100 percent,” she said just the other day, “and I love to walk out to the barn each morning and feed all the pets.  I can’t say enough about Dr. Elder and the other doctors and nurses at the DMC – they were kind and thoughtful and did everything in their power to help me feel reassured and at home.”

Dr. Theodore L. Schreiber, M.D., the President of the DMC Heart Hospital, said that Ms. Rhodes’ recovery was “a terrific example” of how the creation of a specialized PE program can save lives. 

“Dr. Elder and his team have a great deal of experience in treating pulmonary embolism,” said Dr. Schreiber, “and they are using the best technology available in the world to treat this condition.  This is the only program of its kind in Michigan, and I think that’s very good news for all of us who might need their help someday.”

Barb Rhodes says she couldn’t agree more, and that she was so grateful to Dr. Elder – who has also been honored as an Hour Detroit magazine “Top Doc” by his medical peers for the past four years – that she decided to reward him with a gift based on her own professional specialty.

A few weeks after her procedure, she baked him a fragrant apple pie and hand-delivered it to him during a checkup.

Asked about the pie, Dr. Elder lit up.  “Delicious!” he said.  “That was a real treat – it made me feel warm inside.” 

About Detroit Medical Center
Detroit Medical Center includes DMC Children’s Hospital of Michigan, DMC Detroit Receiving Hospital, DMC Harper University Hospital, DMC Heart Hospital, DMC Huron Valley-Sinai Hospital, DMC Hutzel Women’s Hospital, DMC Rehabilitation Institute of Michigan, and DMC Sinai-Grace Hospital. Detroit Medical Center is a leading regional healthcare system with a mission of excellence in clinical care, research and medical education.

Dr. Elder Invited to Pulmonary Embolism Response Team Symposium

When Massachusetts General Hospital hosted its Pulmonary Embolism Symposium last month in Boston, DMC’s Mahir Elder, M.D. was invited to help educate physicians from around the country about some of the latest advances and techniques in PE treatment. Dr. Elder is internationally renowned and an interventional cardiologist at DMC’s Heart Hospital.

The symposium is an event of the National Consortium of Pulmonary Embolism Response Teams, (PERT) founded two years ago “to facilitate the exchange of ideas and information related to the care of patients with PE, and to advance the science of PE care by performing research, developing advanced treatment protocols, and educating clinicians and community members.” The PERT Consortium’s goal is to be “the driving force behind increased survival rates and the future of PE treatment.”

Dr. Elder talked about the DMC ‘s Clotbuster program, an innovative procedure used to treat pulmonary embolism with the support of the RV pump advanced technology. He also shared how these physicians from across the country could start similar Clotbuster programs at their hospitals.

Drug-Coated Balloon for Treatment of Peripheral Arterial Disease
U.S. hospitals this week began using a new medical device from Medtronic plc (NYSE: MDT) called the IN.PACT Admiral drug-coated balloon (DCB) to treat patients with peripheral arterial disease (PAD) in the upper leg, a common cardiovascular condition that causes leg pain and increases the risk of heart attack and stroke.

Detroit Cardiologists

Recently approved by the U.S. Food and Drug Administration, the IN.PACT Admiral DCB offers patients a new therapy option that has demonstrated the best clinical outcomes ever reported for this disease state and has been proven to reduce the need for costly repeat procedures that are commonly associated with other available interventional therapies.

The first uses of the new medical device following FDA approval took place at NewYork-Presbyterian Hospital/Columbia University Medical Center by William Gray; Detroit Medical Center’s Harper Hospital in Michigan by Mahir Elder; Yuma Regional Medical Center in Arizona by Joseph Cardenas of the Heart Center of Yuma; and Terrebonne General Medical Center in Houma, Louisiana by Craig Walker of Cardiovascular Institute of the South.

Read the full article here!

Detroit Cardiologists

Dr. Elder speaks at the VIVA conference
Detroit Cardiologists
VIVA Physicians is a not-for-profit organization dedicated to advancing the field of vascular medicine and intervention through education and research.

Since 2003, VIVA Physicians has held an annual multidisciplinary vascular education conference for physicians and healthcare professionals dedicated to treating patients with vascular diseases. Attendees learn the most current diagnostic techniques and leading edge treatment strategies utilizing innovative technologies and creative learning platforms. The world renowned faculty emphasizes unbiased and critically evaluated educational content that highlights multidisciplinary perspectives and collaboration.

VIVA Physicians are committed to:

  • Promote research
  • Maintain the highest scientific integrity
  • Act as premier educators in the fields of vascular medicine and intervention
  • Advance the field of vascular medicine with a spirit of collegiality
  • Improve the care of patients with peripheral vascular disease.
DMC Specialists Are First in Midwest to Implement “Robotic-Assisted” Revascularization to Relieve Arterial Blockages
Cardiovascular Surgeons

Major breakthrough at DMC Cardiovascular Institute will revolutionize treatment for heart patients with coronary blood-flow disorders, says CVI President Theodore L. Schreiber, M.D.

DETROIT – The Detroit Medical Center (DMC) announced today that a team of heart specialists at its Cardiovascular Institute (CVI) has successfully conducted the Midwest’s first-ever “robotic-assisted” coronary revascularization to relieve heart artery blockages. The successful implementation of the pioneering new treatment procedure – unique in Michigan and so far performed at only three institutions in the United States – means that DMC heart care patients now have access to the world’s most advanced treatment method for relieving blockages in heart arteries, said CVI President Theodore L. Schreiber, M.D.

“This is a major step forward for heart care patients in Michigan and the Midwest,” said Dr. Schreiber, while describing Monday’s successful implementation of the robotic-assisted angioplasty procedure at the DMC CVI.

“What it means is that many DMC heart patients can now enjoy the benefits of the world’s most advanced and proven technology for removing blockages in arteries that feed the heart. Thanks to the remarkably precise arterial navigation advances and the enhanced visualization provided by robotic-assisted revascularization, clinicians will now be able to help heart patients with significantly advanced techniques for using stents or balloons to relieve arterial blockages. These advances will often lead to better patient outcomes – and I don’t think it’s an exaggeration to suggest that this is the dawn of a new era in heart care. Once again, the Detroit Medical Center and the Cardiovascular Institute are leading the way in pioneering a new treatment method that will help heart patients to get better as quickly and painlessly as possible.”

Dr. Schreiber added that the “precision of robotic techniques now applies to percutaneous coronary intervention” (removing arterial blockages with flexible catheters rather than through invasive surgery), and that the new procedure “is expected to markedly diminish ionizing radiation exposure to physicians, patients and staff during the procedure, since it requires fewer [x-ray] pictures. That will also lead to wiser resource consumption, with more precise stent delivery and angiography, thanks to the enhanced visualization provided to the clinicians during the procedure.”

Built around a recently developed technology platform known as “The CorPath 200 System,” the new robotic- assisted revascularization procedure allows the cardiologist to sit at a control panel and operate a robotic arm that guides flexible tubes (known as catheters) through arteries that are blocked by sclerotic deposits or other disorders in patients with cardiovascular ailments. Once in place near a blockage, the catheter can then deliver stents or balloons that will help to restore blood flow by expanding the area around the arterial backup.

“The great thing about this new approach to restoring blood-flow in the artery is that it gives the clinician maximum precision in placing the stent or balloon exactly where it will help most,” said Dr. Schreiber. “At the same time, the cardiologist can see the targeted area of the artery more clearly – even as the enhanced accuracy of movement helps to produce less fatigue in the treating physician’s hands, wrists and arms.”

Dr. Schreiber, a nationally recognized pioneer in using advanced catheterization techniques to treat heart ailments without having to resort to chest-cracking surgery, said that the first patient to undergo the new procedure at the CVI’s catheterization lab was an 84-year-old grandmother of three from Roseville named June Frank.

“This patient had been struggling with several coronary blockages,” he said, “and with the help of the new procedure, we were able to quickly and painlessly restore healthy blood flow around them. The patient felt fine throughout the procedure and showed no ill effects. One day later she reports feeling much more energetic and is in high spirits. She will be discharged later this afternoon, after spending only one day at the hospital.”

A retired homemaker, Ms. Frank said Tuesday that she was “feeling terrific and ready to go home.” She also noted that that she had undergone “six or seven” revascularization procedures in the past, and that “this was the only one where I felt no pain at all. It was quick and it was very easy.”

A resident of Roseville, Ms. Frank has five grown children. After declaring that she was feeling energetic and completely free of pain, she pointed out that she’s an avid Detroit Tigers fan and that she “can’t wait to get back out to the ballpark this spring and watch the Tigers play some more baseball!”

Describing her treatment, Dr. Schreiber said that it was “very exciting to see how effective this new procedure can be in helping patients overcome coronary blockages.”

He was also quick to point that the CVI treated three other patients with the new procedure on Monday, and that all three were doing well. One of those patients underwent a “radial catheterization” in which the flexible tube that carries stents and balloons is inserted through a wrist artery, rather than through the femoral (leg) artery. That procedure, he noted, was the first of its kind to be performed in the U.S.

DMC Cardiovascular Institute Physician is First in Michigan to Use New "Arterial Drill" Catheterization Technique to Remove a Major Blockage
Cardiovascular Surgeons

DETROIT, Oct. 6, 2011 /PRNewswire-USNewswire/ — The Detroit Medical Center (DMC) Cardiovascular Institute (CVI) has become the first cardiac care facility in Michigan to successfully open a patient’s blocked artery with a breakthrough technology that operates like an electrically powered “corkscrew drill” to painlessly remove the plaque buildup which causes Peripheral Artery Disease (PAD).

The 45-minute procedure conducted Wednesday by CVI Director of Endovascular Medicine Mahir D. Elder, M.D. was successful in restoring uninterrupted blood flow through the patient’s femoral artery, which had been obstructed with a 100-percent plaque blockage caused by PAD.

“Yesterday’s successful procedure, completed without invasive surgery and requiring less than an hour, is a significant step forward in the treatment of arterial blockages triggered by chronic arterial disease,” said Dr. Elder. “For the first time in Michigan, a patient with a totally blocked artery was able to benefit from a powerful new technology that can remove even the most severe blockages and without the cutting or stitches that are part of traditional bypass surgery.

“This patient was in danger of losing a foot but thanks to this new procedure that we will now be using with PAD patients from all across Detroit and Southeast Michigan, that risk has been eliminated and she’ll be going home in a day or two.”

The patient who underwent the procedure at the DMC Cardiovascular Institute was a 50-year-old postal worker from the Detroit suburb of Livonia, said Dr. Elder. “This patient had consulted with several physicians in recent years,” he added, “and she’d been told that her only option was invasive surgery to bypass the damaged artery which was 100-percent blocked by PAD-related plaque.

“Fortunately, however, the new ‘corkscrew catheterization’ technique that was unveiled at CVI yesterday doesn’t require surgery at all. Instead, this state-of-the-art procedure uses a drill-like catheter powered by a small electric motor to remove the plaque-buildup on the walls of the artery, quickly and painlessly.”

Because the breakthrough technique doesn’t involve any surgery but only the insertion of a flexible, plastic catheter into the affected artery via a tiny skin incision most patients are spared the pain, risk of infection and extended healing-time that usually result from a surgical operation.

Yesterday’s successful operation at the DMC Cardiovascular Institute was “a highly promising breakthrough in caring for patients with PAD,” said CVI President Theodore L. Schreiber, M.D. “PAD affects up to 20 million Americans today, according to the latest research data, and many of those patients are struggling with severe arterial blockages that often used to require amputation of affected limbs, and especially of the legs and feet.

“We’re very pleased to be the first cardiac care center in Michigan that is now making this pioneering procedure available to patients grappling with chronic artery disease.”

The new FDA-cleared catheterization tool, known as the “Avinger Wildcat Catheter,” uses the automated tip rotation produced by a compatible hand-held motor (the “Avinger Juicebox”) to open up the artery. The tip of the drill is inserted through the catheter directly into the affected artery.

Composed of cholesterol and calcium deposits that are layered onto the surface of aging blood vessels over time, arterial plaque narrows the passageways through which blood flows from the heart to feed the cells of the body. When arteries become too constricted by plaque, the result can be a heart attack, a stroke … or eventual gangrene and amputation of limbs that are being starved by lack of blood.

“The really exciting thing about this new technology is that it can remove blockages which could never be penetrated by traditional catheters before,” said Dr. Elder, who also serves as the Medical Director of the DMC Harper University Hospital Cardiac Care Unit and who has been credited with performing more endovascular surgeries per year than any other Michigan cardiac specialist. “In the past, many patients with severe PAD had no options other than invasive bypass surgery. Each year in this country, nearly 200,000 amputations occur as a result of PAD. But many of those tragic amputations could be avoided by using the cutting-edge technology now available at CVI.

“If you or someone you care about is experiencing the symptoms of PAD (symptoms that can include sharp pain and cramping in leg muscles when walking, or chronic numbness in legs and feet), you should consult with your family doctor about the cause of the discomfort,” said Dr. Elder.

“As with so many other chronic diseases, early detection is the key to repairing the plaque-caused arterial damage that can lead to loss of a limb.”

Copyright © 2018 Heart & Vascular Institute | All Rights Reserved

24/7 ANSWERING SERVICE: (313) 222-0330

Copyright © 2018 Heart & Vascular Institute | All Rights Reserved

24/7 ANSWERING SERVICE: (313) 222-0330

About Our Heart Team

The Heart & Vascular Institute's consortium of award-winning Detroit heart doctors remain dedicated to providing the highest quality of care throughout Michigan and the Midwest.

Cardiovascular Testing

: Aortic Testing
: Echocardiogram Testing
: Venous & Vein Testing
: Vascular & Arterial Testing
: Stress Testing

Cardiac Procedures

: Left / Right Heart Catheterization
: Peripheral Angiogram
: Inferior Vena Cava / removal
: Carotid Venous Angiogram/Stent
: ICD Implant


: 24/7 Emergency: (313) 222-0330
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: Southfield: (248) 424-5000
: Toll Free: 1-(855) 5-Heart-Docs

We proudly serve patients and their families in Detroit, Dearborn, Southfield, Livonia, Farmington Hills, Barton Hills, Bloomfield Hills, Franklin, Lake Angelus, Bingham Farms, Orchard Lake, Bloomfield, Birmingham, Grosse Pointe, Sylvan Lake, Huntington Woods, West Bloomfield, Northville, Grosse Ile, Pleasant Ridge, Plymouth, Rochester, Clarkston, Lathrup Village, Novi, Troy, Rochester Hills, Ann Arbor, Royal Oak, Auburn Hills, Wixom and many other cities in the greater Detroit metro area and throughout Michigan