World peeks inside local operating room World peeks inside local operating room (October 21, 2005)

Doctors around the globe watch El Camino's cardiac lab at work

By Molly Tanenbaum

Through the lens of the video camera, cardiologist Dr. James Joye appeared totally calm. But the procedure he performed on a 90-year-old woman on Oct. 17 for a live audience was hardly simple.

"The stakes are higher," Joye said. "The slightest little detour in a brain procedure can disable a patient."

A broadcast from Joye's operating room at El Camino Hospital was shown live to a conference in Washington, D.C., allowing cardiologists around the globe to learn the latest in cardiovascular therapies.

Joye, director of the cardiac catherization labs at El Camino, specializes in carotid stenting, a relatively new procedure. In front of a video camera, Joye demonstrated how he inserts the wire-mesh tube called a stent into a patient's carotid artery, the large artery in the neck that supplies blood to the brain and is often used for taking a person's pulse.

Once inserted, the stent can act as scaffolding to hold open a portion of the artery previously afflicted with a blockage.

While the procedure to place a stent in a coronary artery comes with the risk of inducing a small heart attack, carotid stenting is even riskier -- if something went wrong, the patient could suffer a stroke, according to Joye.

"In comparison to coronary stenting, which is easily translatable and has been taught to hundreds of cardiologists, the processes of taking catheters in a different direction and getting them into arteries that supply blood to the brain are very different circumstances."

Joye has been working with stents since 1994. He has performed over 500 carotid stent procedures, many of which contributed to FDA trials for new stents, and he has trained over 200 physicians in stent insertions over the past five years, according to a hospital spokesperson.

While the risks involved in carotid stenting are high, the advantages of this procedure are many-fold, especially for elderly patients such as the patient of Oct. 17; she received two carotid stents that day, but otherwise would have required the riskier option, surgery. In contrast to surgery, stenting is far less invasive, does not require general anesthetic, and allows the patient to return home the next day.

During the live broadcast at El Camino, Joye inserted a stent for each of the two blockages in the patient's neck by feeding a catheter from her leg up to the blockage area.

The carotid stents Joye used, Guidant's Acculink and Abbott Laboratories' Xact stent, have only recently earned FDA approval.

The conference, entitled Transcatheter Cardiovascular Therapeutics, or TCT, took place from Oct. 16 to 21 and presented live cases from 27 hospitals around the world. Out of the 14 hospitals in the United States, El Camino was the only facility on the West Coast participating in the conference. Hospitals in Germany, Korea, Brazil and other countries also presented live patient cases to the conference.

This is the 17th year of the TCT conference, but only the first for El Camino. The conference is primarily geared toward cardiologists, and doctors come from around the world to attend.

According to Joye, the next area of work he would like to pursue involves using cardiovascular therapies to work in acute stroke prevention.

E-mail Molly Tanenbaum at mtanenbaum@mv-voice.com

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