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Elective angioplasty at L+M is preventing heart attacks

By Judy Benson

Publication: The Day

Published May 08. 2014 4:00AM   Updated May 08. 2014 7:56PM
Sean D. Elliot/The Day
Cardiologist Brian Cambi inserts a stent in patient William Sinkfield with the help of Radiologic Technologist Nancy McKay during elective angioplasty Monday at the Cardiac Catheterization Lab at L+M.
Hospital has done 105 procedures since early last year

New London — On April 22, Willie and Debra Sinkfield were on one of their frequent visits to Foxwoods Resort Casino to play bingo when their evening took a sudden, scary turn.

"I felt like I couldn't breathe and I was sweating," Willie Sinkfield, 71, recalled Monday. "I had a burning in my chest."

Soon, Sinkfield was being tended by Lawrence + Memorial Hospital medics who whisked him into an ambulance. At L+M, the New Rochelle, N.Y., resident underwent emergency angioplasty surgery to reopen an artery and restore blood flow.

"He was having a big heart attack," said Dr. Brian Cambi, the interventional cardiologist who performed the surgery. "We took care of one artery that was 100 percent blocked off."

Two weeks later, Sinkfield returned to Cambi at L+M, this time for elective rather than emergency angioplasty. It's basically the same procedure, but done on partial blockages to pre-empt the next heart attack. During the first surgery, X-ray images and special dyes had revealed two other constricted arteries that Cambi recommended be repaired in the near future. Sinkfield could have gone to a hospital near his home, but decided he'd rather travel the 100-plus miles back to New London to stick with Dr. Cambi.

"When something goes wrong and the man who fixes it fixes it right, why go to anybody else?" said Sinkfield, who before retirement ran his own tailoring shop and worked in a swimming pool cleaning business.

On his second visit to L+M, Sinkfield became the 105th patient there to have elective angioplasty, a procedure the hospital began offering in February 2013. He left for home Tuesday morning, just 24 hours after his surgery, fully mobile and pleased with the care he'd received.

"I have no pain," he said. "The only bad thing I can say is that the bed was lumpy."

L+M is one of 10 hospitals in the state approved to offer elective angioplasty, and the only one east of the Connecticut River. Hospital spokesman Mike O'Farrell said that when the hospital proposed adding the service as a complement to emergency angioplasty, it projected doing a combined total of 160 to 170 procedures in the first year. After the first 12 months, it surpassed those projections, doing 187 angioplasties - 88 elective and 99 emergency - and it has done an additional 20 elective and 24 emergency cases since March 1. More complex elective cases are sent to Yale-New Haven Hospital as before, but patients like Sinkfield, with just one or two blockages, are ideal candidates for L+M, Cambi said.

"Most elective patients don't come to us after having an emergency angioplasty, but are identified by their cardiologist after having something short of a heart attack, like shortness of breath," he said.

When it approved L+M for the elective procedure, the state Office of Health Care Access noted that the next nearest hospital offering it is 49 miles away and that L+M had a successful track record of providing emergency procedures in affiliation with the Yale-New Haven Heart and Vascular Center since 2009 and would continue to work in affiliation with Yale on the elective cases. Cambi, who has done most of L+M's angioplasties, is medical director of the L+M Heart and Vascular Center and a Yale faculty member. With stylish running shoes under his scrubs and a relaxed, friendly manner both at the bedside and in the operating room, Cambi clearly enjoys explaining the techniques and advantages of angioplasty to patients and students alike.

"Thirty years ago, we had nothing but clot-busting medications," Cambi said, adding that the treatment had significant drawbacks.

In the 1980s, balloon angioplasty was introduced. A tiny, expandable, synthetic tube was inserted to restore blood flow through a blockage. The procedure improved significantly in the 1990s with the addition of reinforcing metal lace stents around the balloon, and then, in 2004, with medicated stents that prevent internal scarring around the affected blood vessels. In the latest incarnation of the procedure, demonstrated by Cambi Monday when he operated on Sinkfield, damaged arteries are accessed and repaired through a vessel in the wrist, using thread-thin wires and tiny tubes the cardiologist maneuvers through the vessels with the aid of X-ray images projected on a monitor.

"Willie, take a deep breath for me, as deep as you can," said Cambi to his patient, who was under "conscious sedation" for the procedure and was able to hear and respond to questions but would be unable to remember anything about the procedure afterwards.

Cambi kept his eyes on the monitor as Sinkfield inhaled.

"That's perfect," Cambi said. When the lungs expanded, he explained, one of Sinkfield's arteries straightened, enabling him to move the guide wire ahead toward the affected area.

After about an hour, the surgery was complete. Sinkfield's surgical wound was a small lesion on the inside of his left wrist that served as the port for the wire and stent. He had lost less blood than he would have from a bad cut.

Cambi had mended one artery that had lost 80 percent of its flow, and determined after a flow test that a second, less severe blockage could be kept from turning into a heart attack with prescriptions for statins, aspirin and other medications.

"Willie, we're done," Cambi said. "It looks great. The one area didn't need a stent, but for the other area, we needed two stents. But it looks beautiful."

Registered nurse Joanne Stevens, one third of the team that assisted Cambi, was by this time finished delivering the nitroglycerine, Heparin and other medications needed during the surgery. She leaned over the operating table to the patient.

"How you doing?" she asked Sinkfield.

"I'm doing all right," he said.

j.benson@theday.com

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