Mitul Patel, M.D., FACC, FSCAI, Associate Clinical Professor of Medicine at UC San Diego, discusses the Pantheris, a revolutionary catheter for PAD.
Interview conducted by Ivanhoe Broadcast News in March 2017.
Tell us about this new atherectomy catheter.
Dr. Patel It is called a Pantheris catheter and it’s used to treat patients with P.A.D. which stands for peripheral arterial disease. Essentially the catheter works by using a blade that cuts out plaque inside the artery. The advantage of this particular catheter is that it has an imaging camera on it which uses a technology called optical coherence tomography. It gives you very nice detailed images inside of the artery and allows you to focus your cutting on diseased segments rather than cutting healthy parts of the artery which can do some damage.
Talk a little bit about before this Pantheris catheter came along, how did you see what you were doing?
Dr. Patel: You used x-ray imaging which doesn’t really show you what’s inside of the blood vessel it shows you a picture of the blood flow through a blood vessel. It can certainly show you where there’s plaque buildup but it doesn’t characterize that plaque. In other words you don’t know if that plaque is made up of heavy calcium or if it’s very soft plaque. Just assume that you’re going to treat the entire vessel and not necessarily just the part of the vessel that’s diseased.
It sounds like a significant change in how you’re dealing with this condition then.
Dr. Patel: In my opinion I think it’s a big step forward. There is already some data to support that and I think more will be coming down the pike as we move along and this technology gets integrated in more and more places.
Can you share any of the data you have so far?
Dr. Patel: The data that we have is in a small number of patients and it shows that this particular device is effective in terms of removing plaque and improving blood flow through blood vessels. We have efficacy data and safety data that shows it works to remove plaque, to improve blood flow and it’s safe to do so. It’s superiority against the other available technology is in the process of being proven.
Is this just for certain people?
Dr. Patel: I don’t know that you could apply it to every single patient you treat with peripheral arterial disease but to a large group of patients with peripheral arterial disease. This particular catheter right now is approved for use in the legs and below so it’s not FDA approved above the groin area in patients.
Is that something that would come next?
Dr. Patel: More than likely, yes. It may require some modifications in the catheter and its ability to cut plaque out of larger blood vessels but more than likely that will be coming down the line.
How long has this been in use, is it still in trial?
Dr. Patel: It is FDA approved and I believe it was approved about eighteen months ago. We got it here as one of the earlier sites at UC San Diego but it’s been used in other institutions certainly and I think it will continue to grow in this market.
Can you explain what PAD is?
Dr. Patel: PAD stands for peripheral arterial disease and it essentially is plaque buildup in blood vessels that supply blood to the limbs. It can be the arms or the legs and you could even broaden it to include blood flow to the brain because we do get plaque buildup in the carotid arteries. If it’s buildup in the legs, people usually experience burning or cramping pain in their muscles that are supplied by those blood vessels when they exert themselves. Walk, run, climb a flat of stairs and those symptoms typically improve when that person rests.
It would manifest itself not necessarily as a heart attack or losing limbs it just gets more and more painful?
Dr. Patel: That’s actually a good point. In some people when it’s in its critical stages or really advanced stage peripheral arterial disease, yes. You can begin to develop gangrene of the digits and the limbs if it’s really extensive. Of course if you get to the point where you have gangrene typically that requires an amputation. So yes, if left untreated it could progress to that stage. You mentioned heart attacks, heart attacks would obviously be a similar process with plaque buildup in the arteries that supply blood to the heart muscle and there is a lot of correlation between the two. In other words a lot of patients with peripheral arterial disease also have coronary artery disease and vice versa.
Is it a lifestyle thing that would allow you to get this disease, is it eating badly, not exercising that kind of thing?
Dr. Patel: The typical risk factors are diabetes, high blood pressure, high cholesterol, smoking those are the four classic risk factors. Anything you can do to avoid getting any of those conditions. If you smoke stop, smoking cessation is a first line therapy actually or lifestyle modification, the first line therapy. Treat all of the risk factors, exercise as much as possible. There are things that we can’t do anything about, there’s family history, age, and those types of things unfortunately we have no control over. The main risk factors if you can avoid getting any of those conditions or if have them aggressively treating those you can prevent and treat peripheral arterial disease as well.
This catheter it’s more accurate for you, for the doctors. Is it also a time saver, a length saver, anything like that?
Dr. Patel: I think in terms of the benefits of this catheter certainly up front when you first begin using it there’s a learning curve to it, once you get used to it, it doesn’t add any time to the case. Long term, and I think we’re going to prove this with data that we’re collecting, our hope is using this catheter does save time because it doesn’t require patients to come back for recurrent procedures. That’s one of the Achilles heel for our current therapies for peripheral arterial disease is the existing technology although it works very well in most patients there are subsets of patients that have to come back for repeat procedures. So we’re hoping that technology where we’re only addressing disease segments can reduce the need for repeat procedures.
END OF INTERVIEW
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