Procedure for Finding Blocked Arteries Gives Patients Options

CINCINNATI—Researchers at the University of Cincinnati (UC) are exploring new options for opening clogged arteries in the kidneys and heart through the use of intravascular ultrasound.

The procedure, which is being offered for the first time at University Hospital, may help patients avoid unnecessary surgery or vascular stents.

Massoud Leesar, MD, professor of medicine in the division of cardiovascular diseases, uses ultrasound imaging and a pressure wire inserted into blocked arteries to determine the severity of a blockage and to evaluate blood pressure at the site. Both factors are important in determining if a stent is needed to open arteries near the heart and kidneys.

Stents are implantable tube-shaped devices made up of a metallic support structure that are used to support weak vessels.  

“When blockage is discovered in a renal or coronary artery, stents are often the first option,” says Leesar, who recently left University of Louisville to join the UC faculty. “But stents may not always be needed. Often, the blockage is minimal and patients can be treated through medical management.”

Intravascular ultrasound involves using an ultrasound image to determine the extent of a blockage in the heart or kidney and develop the most appropriate treatment recommendations.

The ultrasound is accompanied by the use of a wire that is inserted into arteries that appear to have blockage to test blood pressure in those areas.

“Sometimes, an artery that appears to be severely clogged may have more blood flow than one that appears to be open,” he says. “This procedure could save people from undergoing surgery.”

Leesar was the first to perform the pressure wire and ultrasound catheter to determine the severity of blocked arteries in the heart and kidneys in 2004.  

He will speak about this technique along with alcohol septal ablation, which involves injecting alcohol into the heart to decrease thickening that can slow blood flow, at the annual Transcatheter Cardiovascular Therapeutics meeting Oct. 20-25 in Washington, D.C.  

In addition, Leesar and his division colleagues are leading the local arm of the Cardiovascular Outcomes in Renal Atherosclerotic Disease (CORAL) study, a phase-3 trial evaluating treatment options for patients who have high blood pressure and blockage of the renal artery.

Sponsored by the National Institutes of Health, the study will enroll 1,000 patients—500 using stents to clear blockage and 500 using medical management— and monitor them over a five-year period.

“Our hope is to come up with new guidelines that will help us better diagnose and treat our patients,” he says.