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Think of a Roto-Rooter growling away on a stuffed sewer pipe. Now think of a tiny version grinding inside your chest.

This new equipment saves lives, says Dr. Brent Muhlestein, director of research at the Cardiac Catheterization Laboratory at LDS Hospital.Technically, the minute instrument is a "precutaneous atherectomy device." When inserted inside a person's artery, it routs out the plaque.

Plaque buildup is a leading cause of heart attacks. The atherectomy device, however, eliminates it.

"We actually put a device into the artery through the leg," he said. From there, it is advanced up the artery to the neighborhood of the heart, where its rotation cuts away the plaque.

In one method, the plaque is removed through a "nose cone" on the device. Another system uses a diamond-tipped burr that spins so rapidly that it grinds the plaque into microscopic bits. The pieces of debris "are so small that they just pass through the capillaries" and are digested by the body.

Muhlestein and another board-certified cardiologist, Dr. Jeffrey F. Osborn, will answer questions about heart disease today during the monthly Deseret News/Intermountain Health Care feature, Health Care Hotline. They will be available from 10 a.m. to noon to answer questions.

Atherectomy is one of several advances in artery and heart surgery. In some patients, new procedures are more promising than balloon angioplasty alone. In balloon angioplasty, a balloon-like device is fitted inside the artery, then expanded to open the artery. Then the balloon is withdrawn.

"The new thing that we're using more extensively than anything are what are called coronary stents," Muhlestein said. "Stents are made of metal and they're kind of an expandable scaffold."

When expanded, the stent, which is slightly more than a half-inch long, is about the diameter of the artery, which can be about a 10th of an inch across, or a bit more.

An angioplasty balloon is used to insert the small stents into an artery at the site of a blockage. Then the balloon is inflated, which expands the stent so that it is as big around as the artery. The balloon is removed and the stent remains in place.

"It acts like a scaffold, so it holds the artery open." That prevents the artery from collapsing after the balloon is withdrawn, he said. Soon, arterial material grows over the metal wires, anchoring them in place. Blood can flow freely through an area that once was a dangerously narrowed artery.

Stents were tested starting about eight years ago. Used in surgery for about 3 1/2 years, they have been "quite successful," Muhlestein said.

"Probably 99 percent of the time, it's successfully placed," he said of the stents. Once a stent is in place, the artery tends to stay open.

In less than 15 percent of the patients, the artery closes up again. By comparison, in an estimated 30 to 50 percent of balloon-angioplasty operations, the artery eventually closes again and the patient needs another treatment. But for some, angioplasty is "still the best way to go," the physician said.

Can a stent migrate through the body or cause medical mischief in some other way?

Patients have had them in place for five to eight years without trouble, he said.

New drug treatments are also available to prevent blood platelets from clumping together, he added. "It prevents clogging."

For heart patients, the "chances of their living a long time are probably twice as good as they were, especially if they do what their doctor tells them to do," compared with 10 years ago, he said.

The doctor's advice must be followed during the hospital stay and after release, he added.

"Overall, we're kind of excited about the advances in cardiology and heart treatment," Muhlestein said. "It's an area that just in the past decade has had an explosion in new technologies and treatment to take care of patients."

Of course, he said, people should remember a healthy lifestyle and a reduction in risk factors are more important than all of the technological improvements. They can "prevent the need to use these technologies to start with."



Question? Call today

Preventing heart attacks - possibly the most important effort many adults could make to save their own lives - is the subject of today's Health Care Hotline.

The feature, a monthly service of the Deseret News and Intermountain Health Care, allows residents of many states to connect with medical specialists.

Today's experts are Dr. Jeffrey F. Osborn and Dr. Brent Muhlestein, both cardiologists at LDS Hospital, 8th Avenue and C Street.

From 10 a.m. until noon, anyone with a question about heart disease, risk reduction, warning signs of heart attacks or related subjects may call Muhlestein and Osborn toll-free at 1-800-925-8177. If the telephone lines are busy, they should keep trying.

Also, until supplies are exhausted, a free pamphlet on heart health will be mailed to anyone who asks for a copy. Distributed by the American Heart Association, the brochure offers a self-test on heart attack risk and hints about ways to reduce that risk.

To get one, call 237-2135 and leave a message on the answering machine with your name and address.

IHC is a nonprofit health-care organization based in Salt Lake City. It serves residents of Utah, Idaho and Wyoming. IHC has 23 hospitals and clinics, plus affiliated physicians and health insurance plans.