Clearing the Path

Early adoption of new technology has the interventional cardiologists at Ephraim McDowell Regional Medical Center on the cutting edge

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DANVILLE Interventional cardiologists specialize in removing blockages. When something impacts a patient’s blood flow, they clear the way and fix the problem.

Recently, Hussam N. Hamdalla, MD, FACC, FSCAI, and Sharat Koul, DO, FACC, FSCAI, interventional cardiologists and endovascular specialists at the Heart & Vascular Institute at Ephraim McDowell Regional Medical Center (EMRMC) in Danville, have addressed a different type of obstacle to care for their patients. Conditions and procedures that were once referred to larger medical facilities farther away can now be performed in Danville.

“Thanks to the support of the hospital we are able to provide cutting-edge technology,” says Hamdalla. “Most people find it hard to believe that in our small community hospital we have the latest technology to provide and perform procedures as well as some of the bigger hospitals in the surrounding areas.”

“What we do is not a bridge. It completely changes and revolutionizes the way we manage patients.”— Dr. Hussam N. Hamdalla, Ephraim McDowell Regional Medical Center

“Being able to provide the proper care locally is something that attracted me to start here,” explains Hamdalla, who joined EMRMC in 2009. “We have gradually, with the support of the hospital, been able get some of the latest technology available to provide the support that is needed for these very sick patients. Initially, we transferred patients to Lexington, but now no matter how sick a patient is, we are able to handle them all.”

Managing and caring for vascular patients has always been a passion for Hamdalla and Koul. Patients with peripheral arterial disease (PAD) typically will have complete and immediate resolution of their symptoms, noticed the following day when they start walking.

There have been significant advances in the field of vascular medicine within the past few years. These allow endovascular specialists to provide higher success rates with better long-term outcomes. Among those advances are the Ocelot and Pantheras devices, which have had a significant impact within the past few years. According to Koul, EMRMC is the only medical center in the state to have the Ocelot, which they acquired within the past three years.

The Ocelot device uses optical coherence tomographic imaging, which minimizes the radiation exposure to both the patient and the staff, to perform the procedure. Previously cases that could involve up to 20 to 30 minutes of radiation are now cut down to less than few minutes. Furthermore, the imaging minimizes the risk of complications associated with these procedures. The Ocelot device is used in more than 30% of Ephraim McDowell’s vascular procedures now with a success rate of over 80%.

“It’s an optical coherence tomography catheter which allows us to deal with complete occlusions and cross through the true lumen of the artery while also doing this with minimum radiation exposure,” says Koul. “This catheter has an imaging element on it, so when I’m trying to cross the occlusion it keeps me inside the actual vessel. The Ocelot allows me to stay within the lumen of the vessel with very high levels of accuracy.”

Of the Pantheras, which offers image-guided artherectomy, Hamdalla says, “The Pantheras device allows us to pretty much do what the surgeons do, which is the microdissection of the plaque out of the vessel with the imaging capability.” Explaining further, he states, “When the surgeon opens up the vessel, they can see in front of them what they’re cutting out. The Pantheras catheter does the same thing without opening up the vessel. We know exactly where we’re cutting, and it brings a surgical microdissection level to the procedure that we otherwise would have needed surgery to achieve.”

Hamdalla and Koul are part of a five-member cardiovascular team, but it’s another example of teamwork that has led to the medical center’s unique investment in this technology.

“When we discuss this device that can cost hundreds of thousands of dollars, the question is never how much will we get in terms of return on our investment; the question is always how much would that impact patients and change their lives,” says Hamdalla.

“We have a nice opportunity here to explore new technologies and techniques and stay on the cutting edge. We can then determine what works and what doesn’t work,” Koul adds. “We can do things that most other hospitals cannot do because of our adoption of the Ocelot and Pantheras system. We’ve been a rapid adopter of technology. If it doesn’t work, we get rid of it. You don’t know until you try.”

A Shared Passion for Innovation

Much like the vessels they repair every day, Koul and Hamdalla have similar origins, but took different paths to arrive at the same place. Koul, whose father is a pulmonologist, grew up in the Washington, DC, metro area, attended the University of Virginia, and then went to medical school at Kirksville College of Osteopathic Medicine in Missouri. He performed his residency at Cleveland Clinic and a cardiology fellowship at Advocate Illinois Masonic Medical Center in Chicago, followed by an interventional fellowship at the University of Kentucky. After working briefly in Atlanta, he moved back to Kentucky, joining EMRMC in 2011.

Hamdalla also came from a medical family, with no fewer than six family members who are doctors, including his father who is a urologist and his wife who is a general practitioner. He first studied internal medicine at a Brown Affiliated Hospital in Rhode Island, and then interventional cardiology at the University of Kentucky before coming to EMRMC in 2009.

Koul and Hamdalla have a shared passion for technology and staying current on the latest improvements in patient care. Koul says the Ocelot device is just one example of how advancements are changing the ability to treat serious conditions.

Speed of treatment is essential, but so is speed of recovery. By using minimally invasive techniques, the team at Ephraim McDowell is able to limit most of the hospital stays to less than 24 hours. And, it’s not just a temporary fix.

“There’s still that perception that what we do is simply delaying surgery instead of being an alternative to surgery,” states Hamdalla. “What we do is not a bridge. It completely changes and revolutionizes the way we manage patients. A lot of patients these days are considered high risk and too complex for surgery. We are becoming the ‘bail out’ for these patients to provide them with a good outcome.”

Koul agrees that these alternatives to surgery are here to stay and will only become more prevalent as other medical centers adopt these new technologies and procedures.

According to Koul, “The future of vascular disease is going to be very much focused on minimally invasive techniques. The advent of newer technologies will change where the management of these patients occur. It will probably move it from the operating room to the cath lab. People will be able to generate outcomes very similar to surgical techniques that have been the standard bearer for years. I think that standard is shifting right in front of us.”

And nothing is blocking the way.