Having limited options as they treated a patient who faced almost certain death if a solution to her problem wasn't quickly found, two Franciscan St. Margaret Health - Dyer physicians had to think fast.
Dr. Michael Nicholas and Dr. Michael R. Nuyles not only saved the elderly woman's life, but their answer turned out to be only the fourth time the procedure they employed had been done in the world. It earned not only the gratitude of the patient and her family, but international recognition at a recent Transcather Cardiovascular Therapeutics conference, where it received a Best Challenging Case award.
Nuyles presented the case, titled Massive Pulmonary Embolism Treatment with Thrombolysis via Local Drug Delivery Catheter.
The patient, Ann VanderGenugten, had a massive pulmonary embolism – a blood clot in her lung that had traveled from her leg -- this obstructed blood flow through the lungs and threatened her heart function. (see story below)
After being alerted to the situation by Dr. David Braunstein, who initially saw the patient and made the diagnosis, Nicholas said it was obvious "something had to be done quickly" to dissolve the clot and improve blood flow immediately.
"We had used this ClearWay (manufactured by Atrium Medical Co.), drug delivery balloon for other procedures, usually for the legs and heart, but never in the lungs. I thought, 'why not try it?' We had familiarity with it so decided, after consulting with the hospital and the patient and getting approval, to give it a shot and it worked," Nicholas said.
Nicholas, a doctor of osteopathic medicine who has been in practice and with Franciscan St. Margaret since 1985, and is its interventional cardiology program director, said the team quickly "did its homework" and learned the procedure previously had been done by interventional radiologists elsewhere. He consulted with them before performing it.
"This particular balloon gently infuses a drug within the clot to break it up," he said.
The procedure has been performed approximately 40 times since, according to the company, which also confirmed the one done by the Franciscan St. Margaret physicians was the fourth.
The advantage of using ClearWay to treat critical pulmonary embolism is in its atraumatic local drug delivery, which can help restore oxygen saturation by rapid resolution of a clot with less procedure time and lower drug volumes necessary to resolve the clot, compared to traditional systemic IV drug dosing. That can translate into lower health care costs and better outcomes, the company said.
Nuyles, who has been a doctor of osteopathic medicine for seven years and an interventional cardiology fellow at Franciscan St. Margaret for four of those, said presenting the case, so far twice, before the world's top cardiologists, has been a thrill, but helping the patient was most satisfying.
"She was doing poorly and starting to crash. I am very happy she was able to be helped and recover."
Nicholas credited the Franciscan St. Margaret staff's teamwork and the hospital for having the means to deal with the case.
"We had the right personnel and the right equipment. It was a win-win for everyone. This shows that patients do not have to travel to university hospitals to get the best treatment," he said.
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Patient sings praises of life-saving procedure
Ann VanderGenugten was en route to a church meeting when she suddenly found it difficult to breathe.
An ambulance was called and she was taken to the Franciscan St. Margaret Health - Dyer Emergency Department, where it wasn't long before doctors realized she faced a life-threatening problem – a massive pulmonary embolism.
A short time later, through the efforts of her physicians, the Schererville resident, now 83, was on the mend and has felt fine ever since.
"I was told this type of procedure normally wasn't done on older people, but I consented and am glad I did," she said, during a phone call while vacationing in Florida.
These days, "I like to walk and ride my bike, a lot. I also go to a health club in Dyer," she said.
"I am grateful to the doctors and for what they did. It sure saved my life."
Photo: Credited with saving the life of an elderly patient are, from left: Drs. Michael Nicholas, Michael Nuyles and David Braunstein. The physicians were recognized because the procedure used was only the fourth time it had been done worldwide.