Since Bradenton Cardiology Center has been sponsoring blood drives, we have collected 14 units of blood and potentially saved the lives of 42 patients.

March 27, 2013
Treatment of femoropopliteal in-stent restenosis with paclitaxel-eluting stents resulted in favorable outcomes out to 2 years, according to findings from a prospective, multi-arm study.

“In this difficult-to-treat patient population, freedom from clinically driven [target lesion revascularization] was 60.8% at 2 years,” the researchers wrote. “Although revascularization was required for some patients, the TLR procedures were predominantly percutaneous interventions (88%, 37 of 42) and no patients underwent amputation.”

In the study, researchers considered 108 patients with 119 in-stent restenosis (ISR) lesions who were enrolled in a single-arm clinical trial of 787 patients treated with paclitaxel-eluting nitinol stents (Zilver PTX, Cook Medical). Patients (mean age, 68.3 ± 9.4 years; 61.1% men) had a mean lesion length of 133 ± 91.7 mm, and 33.6% of lesions were more than 150 mm long and 31.1% were totally occluded.

The procedural success rate was 98.2%, with a mean of 2.1 (± 1.2) stents placed per lesion. Primary patency was 95.7% at 6 months and 78.8% at 1 year, and the rate of freedom from TLR was 96.2% at 6 months, 81% at 1 year and 60.8% at 2 years.

In all, 40 patients experienced major adverse events, which were all TLRs. The 1-year fracture rate of stents used in ISR lesions was 1.2%.

Before treatment, 81.1% of patients had Rutherford scores of at least 3. By 2 years, 60.9% of patients had Rutherford scores of 1 or less. Both ankle brachial index and walking impairment questionnaire scores significantly improved. There were no significant risk factors associated with loss of patency.

Disclosure: Zeller reports receiving research grants and speaker honoraria from Cook Medical.

Perspective: Dr. Srinivas Iyengar

In this study, Zeller and colleagues provide useful information on an area that has become quite frustrating for physicians who work in the endovascular arena, namely superficial femoral artery (SFA) ISR. Currently, no “silver bullet” therapy exists to assure long-term patency rates in patients who undergo repeat procedures for SFA ISR. Although this study did show high primary patency rates at 6 months (96%), there was a noticeable drop-off at 1 year. Additionally, 40 patients underwent repeat procedures for TLR. Although far from perfect, given the paucity of alternate equally effective modalities to treat SFA ISR, this study does offer some insight on the potential usefulness of drug-coated technology in the peripheral vasculature. Ongoing research, as the authors also comment on, involving drug-coated balloons plus/minus atherectomy will most likely increase our knowledge base on the treatment of this entity. There was also a lack of a control arm in this study, which the authors clearly acknowledge.

Overall, I feel this study adds to the clinician’s armamentarium to treat SFA ISR. Enthusiasm should be tempered, however, as physicians need to consider the financial costs and possible complications of repeat stenting (ie, stent fracture/thrombosis). Future studies involving drug-eluting technology alone or in combination with current therapies will hopefully shed more light on this vexing issue.

Srinivas Iyengar, MD, FACC
Interventional Cardiologist
Bradenton Cardiology Center, Bradenton, Fl

Thursday, March 21, 2013 • 2–7 p.m. • Cost: $50 
Call for appointment: 941-748-2277 x 506

♥WHAT DOES A CORONARY
ARTERY CALCIUM SCORE SHOW?
Coronary artery calcium scoring using Bradenton Cardiology Center’s 64-slice CT scanner can identify the buildup of cholesterol in the heart’s arteries that can lead to heart disease or a heart attack.
Coronary artery plaque calcifies – or hardens – reducing the artery’s size and the amount of blood that can flow to the heart. Calcified plaque can be seen by the CT scan. The amount of calcified plaque present in your heart’s arteries is related to your risk for a heart attack.

♥ WHO SHOULD GET THE EXAM?
Males 35 or older and females 40 or older who have one or more of the following risk factors are encouraged to have this test:

• Family history of heart disease
• Smoker
• High LDL cholesterol
• Low HDL cholesterol
• High blood pressure
• Overweight
• Sedentary or high risk lifestyle

♥ WHAT DOES MY SCORE MEAN?
Your calcium score is a number that corresponds to a level of plaque:
SCORE PLAQUE
0 No evidence of plaque
1-100 Mild amount of plaque
101-400 Moderate amount of plaque
Over 400 Extensive amount of plaque
The higher the score, the more likely one is to suffer
a heart attack or even death.

♥WHAT IS REQUIRED OF ME
DURING THE TEST?
No special preparation is necessary. Before the scan, patients remove all metal objects from the chest area. Patients recline on the CT scanner table as it advances through the donut-shaped scanner.
The scanner will pass over 3 times; each time patients will be asked to hold their breath for 10 seconds or less. The scan is fast and painless.

“By wearing red we are honoring our patients, and bringing attention to women’s heart health issues,” says Mohammed Saghir, M.D., Cardiologist at Bradenton Cardiology Center.

More often than not, recognizing the unique symptoms of a female heart attack may be the key to surviving one.

“The truth is women have more unrecognized heart attacks than men because the symptoms of a female heart attack are not considered typical. The majority of women experience early warning signs of heart attack with sudden onset of extreme weakness that feels like the flu – often with no chest pain at all,” says Dr. Saghir.

Although women can have chest tightness as a symptom of a heart attack, it is also important for women to recognize that might not be their symptom.

Female heart attack symptoms include:

• Chest discomfort with lightheadedness
• Fainting
• Sweating
• Unexplained fatigue
• Pressure in the lower chest, often confused for a stomach issue
• Back pain
• Dizziness

The Go Red for Women campaign strives to raise awareness of the dangers of heart disease among women and encourages women to take steps to reduce the risk of heart disease.

According to the AHA, since the first National Wear Red Day 10 years ago, tremendous strides have been made in the fight against heart disease in women, including:

• 21% fewer women dying from heart disease
• 23% more women aware that it is their number 1 health threat
• Legislation to help end gender disparities

But the fight is far from over, as hundreds of thousands of women still die each year due to unrecognized heart attack symptoms. It is time to stand stronger, speak louder and join us in the fight this National Wear Red Day.

It’s time to Go Red. Join us.

Cathy Payne, USA TODAY

At year-end gatherings, relatives should think about passing along more than just the turkey and fixings at the dinner table. They can share information that can improve and even save lives.

The get-togethers offer an opportunity to gather family health history that can help doctors personalize medical care. For instance, you can ask a relative whether there is a history of diabetes or heart disease in the family. You also can find out if there is a relative to whom you can circle back at a later time for more information.

“It’s a perfect time that we not only visit with our families, but also learn about our family health history,” Surgeon General Regina Benjamin says.

The surgeon general’s office offers My Family Health Portrait, a free, Web-based tool for organizing family health history. After inputting information, you can create and print a diagram and table to present to a health care provider. It is compatible with electronic health records.

“It can help your physician develop a personalized disease-prevention plan centered around you and your family health history,” Benjamin says.

The information is not saved on a government computer or website. But you can save the data to a local storage area, such as your computer or thumb drive. You can continuously update it.

You also can make copies for family members. They can use the information to create their own graphical representations of the data.

Daniel Friedman, an electrophysiology cardiologist at Bradenton Cardiology Center in Florida, agrees that it is important to gather family health history.

Heart disease risk is determined by genetic, lifestyle and other factors, Friedman says. Sharing your family health history will give your physician a better understanding of any increased risk and ways to reduce it, he says.
To get your family’s heart-health history, Friedman suggests finding out the type of heart disease, the age of onset and the treatment, such as surgery. He also suggests finding out about additional disorders or diseases that can make the initially diagnosed illness more severe or more likely to occur. Those are factors doctors call comorbidities, such as diabetes, high cholesterol and hypertension, which tend to run in families.

Ways to get relatives to talk about medical history depend on the relationship and communication.

Friedman says that if it were his family, he would ask, “Do you have any regrets or anything you would change about your health over the last few years?”

Getting family members to talk about their health can help you as well as others.

The surgeon general says, “Learning about your family health history can be a gift to the next generation.”

Since Bradenton Cardiology Center has been sponsoring blood drives, we have collected 14 units of blood and potentially saved the lives of 42 patients.