Cardiology has evolved dramatically - at the Medical Center and around the world - in the past 10 years (advances explored in our related articles on electrophysiology, nuclear cardiology, and echocardiology).

Cardiac catheterization and Coronary Angioplasty - in which pictures are taken of ventricular function and the coronary arteries and devices can be used to treat those blockages - is booming. "Our two laboratories are busy from 7:30 in the morning often until 8 or 9 at night, and we do a large number of emergency procedures off-hours," says Dr. Frederick Ling, Director of the Cardiac Catheterization Laboratory.

All in all, that means busy days (and nights) for Dr. Ling and his colleagues Christopher Cove, M.D., John Gassler, Craig Narins. and Richard M. Pomerantz, M.D. Catheterization is often called for when non-invasive diagnostic studies still leave a question in the mind of the cardiologist. For example, how extensive and severe is this cardiac lesion? Should we consider bypass surgery or angioplasty?

Cardiologists can use catheters to open a stenotic heart valve or dilate coronary arteries or bypass grafts. Interventional catheterization procedures also have multiplied, widening the range of choices to improve cardiac blood flow beyond traditional balloon angioplasty, in which pressure from the balloon widens an artery.

More recent developments include a new kind of rotational atherectomy (in which a diamond-coated Rotoblator "sands away" arterial plaque) and intracoronary stents (used to hold open arterial walls). What happens if a severe blockage is found during diagnostic catheterization?

"A lot of clinical factors need to be considered," says Dr. Ling . "Depending on the number, severity, and appearance of the blockages, we may send a patient for bypass surgery, or we may decide to use conventional balloon angioplasty, stents, or atherectomy."

Angioplasty seems to be most useful when there are one or two blocked arteries. "However, the use of coronary stents and other treatment modalities has increased the type and number of blockages which can be tackled with catheterization techniques obviating the need for cardiac surgery in many cases," said Dr. Ling.

The cardiac catheterization laboratories at Strong Memorial Hospital are also the only laboratories in the Rochester area to provide 24 hour, 7 day a week emergent angioplasty treatment for patients presenting with an acute myocardial infarction (heart attack). "Most hospitals rely on clot busting therapy to open blocked arteries during a heart attack. We feel that the data is rapidly emerging that immediate angioplasty to clear away the blockage is more reliable and effective, with less complications and this results in shorter hospital stays and faster recovery after a heart attack," said Dr. Ling. "We have had great success with this treatment over the past 2 years and our response time, even in the off hours is quite good. This is a credit to our dedicated and experienced catheterization team." This 24 hour availablility can be stressful at times, but the catheterization team's morale remains high knowing they are delivering the best, state of the art care to the patients who come to Strong Memorial Hospital.

The Big Challenge: Keeping Arteries Open

While biomedical research has done wonders in developing new technology, a big challenge remains: How to keep arteries open and free of plaque after they been cleaned out or replaced with new grafts.

"Even reducing cholesterol dramatically doesn't seem to slow the early re-narrowing process after angioplasty or stenting," says Dr. Ling, "although it does help prevent blockages from developing elsewhere in the heart."

The wider open the artery, the better. That's the advantage of the stent, which opens the artery wide and keeps it open. Stents have been shown to dramatically reduce the odds of a blockage returning, he points out. Even when the stent heals, a large lumen, or opening, remains. "There's a lot of work going on to determine the best combination of medicines to lower the chances of further blockage," says Dr. Ling. "In addition we are currently trialing a radiation catheter which has shown significant promise in preventing re-narrowing of the artery after angioplasty or coronary stenting."

There seems little doubt that the Medical Center's catheterization laboratories will only get busier, until someone cracks the secret of more effective prevention and until the general public buys into healthier lifestyles.