Date: 4/7/2006

Technique to reduce chance of stroke comes to patients in St. Mary Medical Center community

A minimally-invasive procedure that helps patients avert a stroke is now available at St. Mary Medical Center in Hobart, giving new hope to those who otherwise had little chance of unclogging the arteries in their neck. The procedure’s availability represents a glimpse at the evolution of medicine; it was not part of the healthcare landscape in Northwest Indiana until it was pioneered within Community Healthcare System in 2002.

Cesar Jara, M.D., an interventional cardiologist on staff at St. Mary Medical Center, this month performed the hospital’s first carotid stent placement — a precise and highly-technical intervention that opens blocked arteries in the neck to help patients avert a stroke. The patient, 49-year-old Helen Sargent of Valparaiso, is doing well. Cardiologists Szabolcs Szabo, M.D., and Harish Shah, M.D., also are credentialed to perform the procedure at St. Mary, and others are expected to follow.

“Just 5 years ago, someone like Helen who was not a good candidate for the standard carotid artery surgery had very few options for treatment and faced a situation much more grave than today,” Jara said. “We have an opportunity to look at the evolution of medicine in the exciting field of vascular intervention as we move forward with the common goal of helping our patients obtain the best treatments.”

Carotid artery stenting is done in the cardiac catheterization lab while the patient is awake but sedated. It involves threading a catheter through the vessel and implanting a tiny wire mesh tube (stent) into the artery in the neck to keep it open so blood can flow freely to the brain. Special systems, such as the Accunet Filter by Guidant Corporation, allow the physician to capture and remove any plaque that may break off during the procedure, greatly reducing the risk that the material will travel to the brain and contribute to a stroke.


Because of the artery’s proximity and service to the brain, the procedure is considered highly sensitive and is approved by the FDA only for a certain population of patients who are not candidates for the gold standard treatment, which is carotid artery surgery. Sargent, the St. Mary Medical Center patient, already had surgery on her carotid arteries five years ago, and performing surgery on them again would have been too risky.

Jara is not able to predict when carotid artery stenting will be available to all patients with blocked arteries in the neck, but says endovascular treatments are evolving so rapidly that in the future, they most likely will be as good as surgery when performed by properly trained and certified physicians.

“We are happy to bring this therapy to patients in our community because it shows that our doctors and cath lab staff are moving forward with medicine to make sure our community has access to every available option for battling stroke and artery disease,” says Milt Triana, administrator at St. Mary Medical Center in Hobart.

Jara said he is proud to have had a fellowship in interventional cardiology at the University of Miami, and further special training in carotid stenting under Jon S. Matsumura, M.D., a nationally-recognized physician who works with Guidant Corporation to proctor physicians on this procedure.

“Dr. Matsumura, a vascular surgeon, is one of the best examples of how physicians of different specialties can choose to work together. This is a field where multiple specialties can cooperate to provide the best care possible to our patients,” Jara said.

Each doctor who performs carotid artery stenting must complete several cases under proctorship before becoming credentialed to perform it as part of his practice.

Physicians Prakash Makam, M.D., and Arvind Gandhi, M.D. at St. Mary Medical Center’s sister hospital — Community Hospital in Munster — pioneered the procedure in Northwest Indiana in 2002. Doctors at St. Catherine Hospital — also a Community Healthcare System facility — are in the process of being credentialed to make the procedure available in that community.

“At the hospitals of Community Healthcare System, we have progressive physicians across many specialties who stay abreast of the latest treatment options and take the necessary steps to make sure our communities have access to innovative therapies,” says John Gorski, senior vice president of hospital operations for Community Healthcare System. “To see this same standard of care available all across Northwest Indiana, and even into Illinois, is extraordinary.”