There’s a new weapon in the treatment of Peripheral Artery Disease, or PAD.
Peripheral Artery Disease is a common circulatory problem that can affect feet and lower legs and may lead to amputation.
This breakthrough, minimally-invasive, lumivascular technology is called Lightbox and Saint Peter’s University Hospital in New Brunswick is the first and only hospital in Central New Jersey to have it. (It is also available in other limited locations outside Central New Jersey.)
With real-time intravascular imaging emanating from light waves at the tip of a catheter, physicians can open artery blockages with enhanced safety and higher success rates.
Dr. Ramzan Zakir, cardiologist and director of the Peripheral Vascular Program at Saint Peter’s, calls this a “game-changer” in the treatment of PAD.
Selected Podcast
Light Box, Lumivascular Technology
Featured Speaker:
For more information about Saint Peter’s Healthcare System
Ramzan Zakir, MD
Ramzan Zakir, M.D., is a specialist in cardiovascular disease. He is one of the first physicians in the Northeast to be trained and licensed in the use of Lightbox technology for the treatment of peripheral artery disease (PAD). Zakir performs more than a dozen cardiac procedures, including cardiac catheterization and angioplasty. He is a 2002 graduate of the University of Medicine and Dentistry of New Jersey medical school.For more information about Saint Peter’s Healthcare System
Transcription:
Light Box, Lumivascular Technology
Bill Klaproth (Host): There is a new weapon in the treatment of peripheral artery disease or PAD. Peripheral artery disease is a common circulatory problem that can affect feet and lower legs and may lead to amputation. But there’s a new breakthrough: a minimally invasive lumivascular technology called Lightbox that is now used to treat it. Saint Peter’s University Hospital is the first and only hospital in central New Jersey to have it.
We are pleased to have Dr. Ramzan Zakir, cardiologist and director of the peripheral vascular program at Saint Peter’s with us. He is one of the first physicians in the northeast to be trained and licensed in the use of Lightbox technology.
Dr. Zakir, thank you so much for being on with us today. So, let’s get right to it. What is PAD or peripheral artery disease?
Dr. Ramzan Zakir (Guest): Peripheral arterial disease is one of the cardinal manifestations of atherosclerosis. We’re all familiar with atherosclerosis. It’s when you have a plaque buildup in the arteries. In the heart, it could lead to chest pains and it could lead to heart attacks. In the legs, when you have plaque build-up, it reduces the flow to the feet and this could lead to excruciating pain when one walks. When one walks a certain distance, they have to stop due to excruciating pain and that’s called claudication. Other manifestations of peripheral arterial disease, more in the later stages, is if a patient were to have a wound and if there’s decreased blood flow, that patient could be risk for amputation if the blood flow is not restored.
Bill: So, you’re talking about pain in the feet. Can you describe that a little better? Is that in the heel or the whole foot or the whole lower leg? Just so somebody who may be listening can determine, “Maybe this is me.”
Dr. Zakir: Right. It depends on the location of the blockage. The areas where there’s complaint of pain is in the buttock area, the thighs, and the most common places, in the calves. Then a later manifestation is in the feet, when the feet hurt all the time.
Bill: Does it feel like a cramp when you’re talking about the calf or the buttocks? I mean, does it feel like a cramp or is it just a sharp pain?
Dr. Zakir: It’s more of a dull pain. It’s an excruciating pain. It’s a pain that occurs during exertion and it’s usually reproducible, in the sense that once you walk a certain amount of distance, that patient that has that pain has to stop for a little bit more and then can walk a little bit more and gets the pain again. Usually, the patients will tell you, “Every time I walk half a block, I have to stop because of the pain.”
Bill: PAD really hinders the quality of life for patients then?
Dr. Zakir: Exactly. Because these people that were active and they were able to partake in the normal activities now find it very difficult to do so.
Bill: Is that the usual telltale sign: a short distance and you’re feeling this excruciating pain in such a short walk?
Dr. Zakir: That’s the typical, classic presentation. Unfortunately, a lot of patients who have PAD are asymptomatic or have atypical symptoms, but the classic description is exactly that as you just described it.
Bill: Okay. Now, how is it typically treated? Before we get to Lightbox, how was it treated before?
Dr. Zakir: The first line is medicines and exercise. There are some drugs that do improve the ability to walk a little bit more. And then, traditionally, it was a surgical bypass that was performed. However, it’s a very invasive procedure associated with some mortality and morbidity and infections. And now, what’s becoming more and more common is a catheter-based procedure to open up the blockages. It’s a same-day procedure; it’s just a little catheter goes in the groin and we’re able to open up the blockages in a minimally, non-invasive way.
Bill: Is that what the Lightbox treatment is then?
Dr. Zakir: Lightbox is a way to treat with the endovascular, with the catheter-based therapy. A lot of times, these patients have what we call a chronic total occlusion. That’s when the artery is totally blocked. It’s not narrowed. Significantly, the artery is totally blocked and the artery in the leg, it could be blocked for a long portion of the leg. To open it up with the traditional approach with the catheter and the wire could be difficult because we’re kind of poking the wire and we’re kind of hoping we go in the right direction; we’re kind of navigating in the dark. That approach is pretty good but we’re always working on trying to improve our methods of opening up these blockages. What the Lightbox does, it has what we call an OCT fiber which emits light waves at the tip of the catheter and we’re able to see what’s inside the artery, so when we’re trying to open up these long, total blockages, it makes it a lot easier and safer to open up these blockages. Once we’ve crossed the total blockage, then we can balloon and stent and treat the patient to improve the patient’s symptoms. But the first line …
Bill: Go ahead.
Dr. Zakir: The problem is crossing the blockage. With the traditional approach, the failure rate could be from 13% to 34%. In the study looking using the Lightbox and this Ocelot catheter success rate was up to 97%. We’re improving our ability to cross these blockages and improving safety as well.
Bill: So, it seems like there is really twofold benefits to the Lightbox technology. One is it’s minimally invasive because you don’t have to surgically go into the leg to get to the diseased artery. Two is it’s a lot more effective because you’re going right into the vein that is clogged and you’re able to unclog it basically with the light at the end of your device there.
Dr. Zakir: Exactly. You’re able to image and you know exactly where you are, so you’re able to navigate the catheter towards the plaque, towards the blockage and away from the healthy part of the artery. Because when we do it the traditional approach, we’re poking around and we’re hoping we’re going in the right direction. This way, we know we’re going in the right direction.
Bill: You probably have much less recovery time as well.
Dr. Zakir: Right. The recovery time from these endovascular procedures, often, we close the artery and patients are walking two hours after the procedure. Most of the time, it’s a same-day procedure. They go home the same day.
We did a case just a few days ago. Patient had pain for five years and we did the procedure. We used the Lightbox, we’re able to get through, deliver definitive therapy, balloon stent. He got up, he walked off the table. Two hours afterwards, he was walking. The next day, we got a call that he’s able to walk with the pain totally gone. It changed his life.
Bill: Amazing. He’s probably able to walk around the block for the first time in a long time.
Dr. Zakir: Right. Exactly. It’s a life-changing experience.
Bill: Absolutely. So, how long does this last for then? Is this like, “Hey, you’re good for five years or ten years?” Is there any kind of way to tell so far?
Dr. Zakir: That’s a great question. That has more to do with just if we stent or if we balloon. Re-stenosis rates are higher; re-stenosis meaning getting blocked up again. It’s higher for the legs than it is for the heart. But on the horizon we have excellent treatments coming down the pipe with the drug-coated balloons, even bioabsorbable stents and even drug-eluting stents. The technology is getting better and the ability to stay open is improving. We’re even getting better on that end as well.
Bill: That is terrific. In our last minute, Dr. Zakir, what is your best advice to someone who feels like they may have PAD?
Dr. Zakir: To go to their primary care doctor. Then they can just further work it up with the initial test that’s usually what we call an ABI, an ankle-brachial index—that can give an idea if there’s PAD or not—and then from there, a referral to a specialist.
Bill: Sounds good. Dr. Zakir, thank you so much for your time today. For more information on PAD, please visit saintpetershcs.com. That’s saintpetershcs.com. This is Saint Peter’s Better Health Update. I’m Bill Klaproth. Thanks for listening.
Light Box, Lumivascular Technology
Bill Klaproth (Host): There is a new weapon in the treatment of peripheral artery disease or PAD. Peripheral artery disease is a common circulatory problem that can affect feet and lower legs and may lead to amputation. But there’s a new breakthrough: a minimally invasive lumivascular technology called Lightbox that is now used to treat it. Saint Peter’s University Hospital is the first and only hospital in central New Jersey to have it.
We are pleased to have Dr. Ramzan Zakir, cardiologist and director of the peripheral vascular program at Saint Peter’s with us. He is one of the first physicians in the northeast to be trained and licensed in the use of Lightbox technology.
Dr. Zakir, thank you so much for being on with us today. So, let’s get right to it. What is PAD or peripheral artery disease?
Dr. Ramzan Zakir (Guest): Peripheral arterial disease is one of the cardinal manifestations of atherosclerosis. We’re all familiar with atherosclerosis. It’s when you have a plaque buildup in the arteries. In the heart, it could lead to chest pains and it could lead to heart attacks. In the legs, when you have plaque build-up, it reduces the flow to the feet and this could lead to excruciating pain when one walks. When one walks a certain distance, they have to stop due to excruciating pain and that’s called claudication. Other manifestations of peripheral arterial disease, more in the later stages, is if a patient were to have a wound and if there’s decreased blood flow, that patient could be risk for amputation if the blood flow is not restored.
Bill: So, you’re talking about pain in the feet. Can you describe that a little better? Is that in the heel or the whole foot or the whole lower leg? Just so somebody who may be listening can determine, “Maybe this is me.”
Dr. Zakir: Right. It depends on the location of the blockage. The areas where there’s complaint of pain is in the buttock area, the thighs, and the most common places, in the calves. Then a later manifestation is in the feet, when the feet hurt all the time.
Bill: Does it feel like a cramp when you’re talking about the calf or the buttocks? I mean, does it feel like a cramp or is it just a sharp pain?
Dr. Zakir: It’s more of a dull pain. It’s an excruciating pain. It’s a pain that occurs during exertion and it’s usually reproducible, in the sense that once you walk a certain amount of distance, that patient that has that pain has to stop for a little bit more and then can walk a little bit more and gets the pain again. Usually, the patients will tell you, “Every time I walk half a block, I have to stop because of the pain.”
Bill: PAD really hinders the quality of life for patients then?
Dr. Zakir: Exactly. Because these people that were active and they were able to partake in the normal activities now find it very difficult to do so.
Bill: Is that the usual telltale sign: a short distance and you’re feeling this excruciating pain in such a short walk?
Dr. Zakir: That’s the typical, classic presentation. Unfortunately, a lot of patients who have PAD are asymptomatic or have atypical symptoms, but the classic description is exactly that as you just described it.
Bill: Okay. Now, how is it typically treated? Before we get to Lightbox, how was it treated before?
Dr. Zakir: The first line is medicines and exercise. There are some drugs that do improve the ability to walk a little bit more. And then, traditionally, it was a surgical bypass that was performed. However, it’s a very invasive procedure associated with some mortality and morbidity and infections. And now, what’s becoming more and more common is a catheter-based procedure to open up the blockages. It’s a same-day procedure; it’s just a little catheter goes in the groin and we’re able to open up the blockages in a minimally, non-invasive way.
Bill: Is that what the Lightbox treatment is then?
Dr. Zakir: Lightbox is a way to treat with the endovascular, with the catheter-based therapy. A lot of times, these patients have what we call a chronic total occlusion. That’s when the artery is totally blocked. It’s not narrowed. Significantly, the artery is totally blocked and the artery in the leg, it could be blocked for a long portion of the leg. To open it up with the traditional approach with the catheter and the wire could be difficult because we’re kind of poking the wire and we’re kind of hoping we go in the right direction; we’re kind of navigating in the dark. That approach is pretty good but we’re always working on trying to improve our methods of opening up these blockages. What the Lightbox does, it has what we call an OCT fiber which emits light waves at the tip of the catheter and we’re able to see what’s inside the artery, so when we’re trying to open up these long, total blockages, it makes it a lot easier and safer to open up these blockages. Once we’ve crossed the total blockage, then we can balloon and stent and treat the patient to improve the patient’s symptoms. But the first line …
Bill: Go ahead.
Dr. Zakir: The problem is crossing the blockage. With the traditional approach, the failure rate could be from 13% to 34%. In the study looking using the Lightbox and this Ocelot catheter success rate was up to 97%. We’re improving our ability to cross these blockages and improving safety as well.
Bill: So, it seems like there is really twofold benefits to the Lightbox technology. One is it’s minimally invasive because you don’t have to surgically go into the leg to get to the diseased artery. Two is it’s a lot more effective because you’re going right into the vein that is clogged and you’re able to unclog it basically with the light at the end of your device there.
Dr. Zakir: Exactly. You’re able to image and you know exactly where you are, so you’re able to navigate the catheter towards the plaque, towards the blockage and away from the healthy part of the artery. Because when we do it the traditional approach, we’re poking around and we’re hoping we’re going in the right direction. This way, we know we’re going in the right direction.
Bill: You probably have much less recovery time as well.
Dr. Zakir: Right. The recovery time from these endovascular procedures, often, we close the artery and patients are walking two hours after the procedure. Most of the time, it’s a same-day procedure. They go home the same day.
We did a case just a few days ago. Patient had pain for five years and we did the procedure. We used the Lightbox, we’re able to get through, deliver definitive therapy, balloon stent. He got up, he walked off the table. Two hours afterwards, he was walking. The next day, we got a call that he’s able to walk with the pain totally gone. It changed his life.
Bill: Amazing. He’s probably able to walk around the block for the first time in a long time.
Dr. Zakir: Right. Exactly. It’s a life-changing experience.
Bill: Absolutely. So, how long does this last for then? Is this like, “Hey, you’re good for five years or ten years?” Is there any kind of way to tell so far?
Dr. Zakir: That’s a great question. That has more to do with just if we stent or if we balloon. Re-stenosis rates are higher; re-stenosis meaning getting blocked up again. It’s higher for the legs than it is for the heart. But on the horizon we have excellent treatments coming down the pipe with the drug-coated balloons, even bioabsorbable stents and even drug-eluting stents. The technology is getting better and the ability to stay open is improving. We’re even getting better on that end as well.
Bill: That is terrific. In our last minute, Dr. Zakir, what is your best advice to someone who feels like they may have PAD?
Dr. Zakir: To go to their primary care doctor. Then they can just further work it up with the initial test that’s usually what we call an ABI, an ankle-brachial index—that can give an idea if there’s PAD or not—and then from there, a referral to a specialist.
Bill: Sounds good. Dr. Zakir, thank you so much for your time today. For more information on PAD, please visit saintpetershcs.com. That’s saintpetershcs.com. This is Saint Peter’s Better Health Update. I’m Bill Klaproth. Thanks for listening.