From the Winter 2012 Vim & Vigor
New EKOS uses ultrasound to improve clot treatment and potentially save lives
Kathleen Mario feels as if she dodged a bullet.
When the 47-year-old Porter resident’s leg began to swell last May, she didn’t pay much attention, attributing it to a recent fall and slow recovery from back surgery a few months earlier. After all, it wasn’t painful.
But what she didn’t know was that it was life-threatening.
Mario’s physician recommended she go to St. Mary Medical Center for a vascular ultrasound to evaluate her for the presence of blockages in arteries and veins.
“The technologist saw immediately that I had a large clot in my thigh,” Mario says. “It started at the top of my leg, and continued all the way to my knee. The technologist called my physician and I was admitted to the hospital right away.”
The danger in Mario’s condition called deep vein thrombosis, or DVT, is that a portion of the clot could break off and travel to her lungs, causing a pulmonary embolism, which could be fatal within a few hours. Removing the clots as quickly and safely as possible became a life-or-death priority.
“Traditionally, we treat DVT with blood thinners or by delivering thrombolytics such as tPA, directly to the clot through endovascular catheterization techniques,” says Anas Safadi, M.D., fellowship-trained interventional cardiologist on staff at St. Mary Medical Center.
“The difficulties associated with those options are that they usually take three to five days of exposing the patient to strong doses of medications, which carries its own risks, as well as multiple trips to the Cardiac Catheterization Lab to monitor the dissolution of the clot. Thankfully, we have a new technology that offers significant enhancements to those traditional options.”
Ekosonic Endovascular System (eKOS)
Figure One: Without Ultrasonic Energy. Tightly wound fibrin strands in a blood clot prevent deep penetration of clot-busting medications.
Figure Two: With Ultrasonic Energy. EKOS ultrasonic energy causes the fibrin strands to thin, making the clot more permeable to clot-busting medications.
Figure Three: With Ultrasonic Energy and Thrombolytic. The EKOS catheter delivers medication into the deepest parts of the clot, making the medication more effective and limiting the amount that escapes.
AN IMPROVED PROCEDURE
The new technology, Ekosonic Endovascular System (EKOS), uses standard catheterization techniques, but takes them a step further. With EKOS, ultrasound energy is sent through a wire in the middle of the catheter. It causes a vibration that helps loosen the fi brin strands within the clot, allowing deeper penetration of clot-busting medication. The result is a quicker, more effective treatment of the blockage with less risk of complications, such as postthrombotic syndrome.
“The time of treatment is greatly reduced when you compare it to the standard method of treating DVT or peripheral arterial occlusions,” adds Safadi. “In the vast majority of patients, you can complete treatment within 24–48 hours. Not only is treatment time reduced, but because the ultrasound allows the medication to infuse deeper and more completely into the clot, we can cut the dosage by 50 to 80 percent. All of this has tremendous benefi ts for the patient.”
“Kathleen had 100 percent blockage of the vessel from above her knee into her lower abdomen,” says George Boodram, director of Cardiology Services at St. Mary Medical Center. “Because of this new technology, we are able to safely dissolve blood clots and have patients resume their normal activities within a relatively short period of time. And because we use about half the medication in half the time, it allows treatment for individuals who may not be able to tolerate high doses of clot-busting drugs.”
EASIER RECOVERY
“Nearly 30 to 40 percent or more of patients with extensive DVT go on to develop chronic lower extremity pain and swelling known as post-thrombotic syndrome,” Safadi says. “These patients experience significant pain that greatly diminishes their quality of life. Using EKOS to treat extensive DVT greatly reduces the chance post-thrombotic syndrome will develop.”
After the treatment, it didn’t take long for Mario to count her blessings.
“Dr. Safadi has a great bedside manner,” she says. “He showed me the photos of my leg before and after treatment. It was amazing to see the difference. I can’t believe I didn’t know that was going on inside me. I’m so thankful that this technology was available for him to perform this lifesaving procedure.”
Advantages of EKOS:
- Allows treatment in difficult-to-reach places, such as behind valves
- Shorter duration of treatments
- Lower dosages of clot-busting drugs, such as tPA, needed
- Complete dissolution of clot obstruction
- Less time required in cath lab, thereby reducing radiation exposure
- Reduced risk of bleeding complications
Be Good to Your Heart Could your heart use a little extra love and care? To find a cardiologist on staff at St. Mary Medical Center, call our physician referral line toll-free at 866-836-3477 or visit us online at www.comhs.org/stmary.