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Stent operation called unique (4-3-00)

A cardiologist from The University of Texas Health Science Center at San Antonio and his colleagues from the South Texas Veterans Health Care System (STVHCS) have performed an apparent medical first: stenting of both carotid arteries and stenting and angioplasty of three coronary arteries during the same procedure. Stents are tiny wire tubes placed inside diseased arteries to keep them open.

"To my knowledge the bilateral carotid stenting and three-vessel coronary intervention have never been done at the same setting," said R. Stefan Kiesz, M.D., FACC, who led the operating team. He is associate professor of medicine at the Health Science Center and interventional cardiologist/director of the cardiac catheterization laboratories at the STVHCS Audie L. Murphy Division. During the procedure March 17 at Audie Murphy, physicians inserted catheters through the patient’s groin and threaded them inside the affected arteries.

The patient, 73-year-old Robert Reyna, was cleared to go home March 19. A veteran of the Korean War, he lives in Monte Alto, 14 miles from McAllen in the Lower Rio Grande Valley. He was referred to Dr. Kiesz by neurosurgeons who were concerned that doing conventional surgery on the carotids would be too risky because of Mr. Reyna’s coronary blockages. The patient suffered no complications and has resumed normal activities.

"I feel much better than before," Reyna said in a phone interview a few days after the procedure. "I was always tired. Walking to the mailbox, I would need to stop two or three times. But yesterday, I walked there without getting tired. Today I walked around my house and washed the car."

Physicians in the STVHCS McAllen VA Outpatient Clinic, including Mario Guerra, M.D., sent Reyna to San Antonio for an angiogram to reveal his blockages. The result: obstruction of both arteries in his neck (the carotids, which supply blood to the brain) and several arteries around his heart. "I was supposed to go to surgery," Reyna said, "but they recommended cardiac catheterization instead."

Stenting of carotid arteries is done only for patients whose heart conditions preclude carotid endarterectomy, the technical name for the operation to clear out clogged carotid vessels. Rarely are both carotid arteries treated in the same procedure. "We performed the equivalent of three surgeries at the same time using minimally invasive techniques," Dr. Kiesz said.

"The procedure that Dr. Kiesz and his colleagues carried out is a remarkable achievement," said Albert E. Raizner, M.D., professor of medicine at Baylor College of Medicine and director of the cardiac catheterization laboratory at Methodist Hospital in Houston. "What they performed in one non-surgical, catheter-based procedure would ordinarily have required two or three surgical operations, with extensive hospitalization and recovery time, to have accomplished."

M. Marius Rozek, M.D., assistant professor of medicine and one of Dr. Kiesz’s colleagues, said he was not aware of another group performing a similar procedure in a single setting. He cited a case, reported in the February 1997 issue of the journal Catheterization & Cardiovascular Diagnosis, in which a patient received stents in both carotid arteries and stents in two coronary arteries. However, physicians performed that intervention in two procedures four weeks apart. Stents were placed in one carotid and one coronary artery during each procedure. The paper authors were from The University of Alabama at Birmingham.

Reyna, a U.S. Army soldier wounded a few days before the cease-fire in Korea in 1953, was decorated with the Purple Heart. After his tour of duty, he took a civil service position at Harlingen Air Force Base. When the base closed a few years later, he began 10 years of service with the U.S. Department of Agriculture’s Screwworm Eradication Program.

Contact: Will Sansom