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Ask a Doc: Advances in Interventional Cardiology

In our Ask a Doc series, we sit down with physicians and other clinical experts across our networks, including at Allegheny Health Network (AHN), for a chat on an important health topic. In this edition, we’re talking with Dr. Matthew Becker about interventional cardiology.

Interventional cardiology is one of the newest and fastest-growing, not to mention fastest-changing, medical specialties. Advances in this specialty are changing patients’ lives every day.

To find out more about interventional cardiology, I talked to Dr. Matthew Becker, an interventional cardiologist at Saint Vincent Hospital in Erie.

Bryce Walat (BW): Dr. Becker, what exactly is “interventional cardiology”?

Dr. Matthew Becker (MB): Interventional cardiology is a sub-specialty of cardiology, which is the treatment of conditions that affect the heart and blood vessels that make up the circulatory system.

Interventional cardiology first focused on performing cardiac catheterizations to use angioplasties or stents to open coronary arteries in the heart that are blocked or narrowed by excessive cholesterol deposits. Before these procedures were invented, doctors performed open-heart surgeries to bypass or clear those arteries.

In the last few years, this field has expanded to encompass treatments for the entire circulatory system, such as stents for leg arteries, as well as problems with veins and structural heart problems, such as bad valves or holes in hearts. Interventional cardiology advances mean that many conditions that used to be treated with open surgery can now be treated with minimally invasive procedures.


BW: What conditions do interventional cardiologists like you treat?

MB: Heart attacks and chest pain from narrowed or blocked coronary arteries make up the bulk of the types of conditions we treat. We also treat peripheral arterial disease, which is a condition that occurs when arteries in your legs or other extremities become blocked or narrowed and cause symptoms like pain and prevent wounds from healing.

We also can treat blood clots in the legs and pulmonary embolisms (blood clots in the lungs) that also used to require more invasive surgeries. We sometimes work with vascular surgeons to treat these clots, as well as to repair abdominal aortic aneurysms.

A recently developed procedure called transcatheter aortic valve replacement, or TAVR, lets us replace defective aortic valves with stents.

BW: What are the benefits of “minimally invasive” treatments versus traditional ones?

MB: Minimally invasive treatments can mean less pain, a shorter recovery and rehab time, shorter hospital stays (and in some cases, no hospital stay), a reduced risk of complications, less time in surgery, and better outcomes than traditional treatments.

Keep in mind that not everyone can benefit from these treatments. Depending on your condition, the traditional treatments may be best for you, and that decision is best left to your doctor. Of course, it’s always a good idea to get a second opinion.

BW: Tell me about some of the latest innovations and advances in interventional cardiology.

MB: One very promising procedure that’s actually been around for a while now is carotid artery stenting. The carotid artery is the artery in your neck that supplies blood to your brain. Like the rest of your arteries, this artery can become narrowed. In the past, the only option to treat narrowed carotid arteries was intensive surgery that involved long recovery times and a significant risk for complications.

We’ve improved and perfected stenting such that we can treat this problem without the need for that surgery. Along with the stent, we put a “filter” in the artery to prevent any clots or other debris from reaching the brain, reducing the risk of blockages that can cause strokes.

It typically takes only four to eight minutes to place the carotid artery stent. During the procedure, patients are awake and alert, and they can go home from the hospital the next day in most cases.

BW: What other kinds of doctors do you work with?

MB: We work as part of a multidisciplinary cardiovascular care team. Depending on the conditions we’re treating, this team can have surgeons, other cardiologists, primary care doctors, social workers, physical and occupational therapists, and others involved in care. We take a look at all aspects of care — nothing we do is in isolation.

BW: What do you see as the future of heart care?

MB: Interventional cardiology is changing at a rapid pace. New technologies and procedures are coming out all the time. The devices we use keep getting smaller, easier to use and more effective.

What’s more, interventional cardiologists will become even more specialized in the care they provide. For example, expect to see more doctors who focus on one procedure or one part of the circulatory system.

One particular area where there’s a lot of promise is what you might call “remote medicine” or telemedicine. We’re already working with remote technologies to perform procedures, as well as see patients and consult with other providers via online video. That also includes mobile apps and other remote patient monitoring technologies for monitoring conditions and tracking progress in treatment and recovery. As remote technologies become better, faster and cheaper, we’ll no doubt see them being used more often.

BW: What’s a typical “day in the life” of an interventional cardiologist?

MB: First of all, there’s no such thing as a “typical day” in interventional cardiology. But here’s an example of how you might spend your time as an interventional cardiologist.

You may spend the morning in your office meeting with patients, and later that afternoon, you may be putting in a stent or performing an angioplasty. That evening, you may be called to go to the hospital to do an emergency cardiac catheterization because a patient just came into the emergency room having a heart attack.

You’ll also spend time consulting with other doctors to help them decide how to treat patients, as well as share what you’ve learned and find out what others are doing to keep improving your care.

BW: Do interventional cardiologists do anything related to preventive care?

MB: Although we spend most of our time treating conditions people already have, we also work with people who are at risk of having certain conditions due to genetics, lifestyle or medical history. We also work to prevent reoccurrence of the problems that we treat.

BW: What do you think makes Allegheny Health Network unique when it comes to heart care?

MB: What I think really sets us apart from other health care systems is that all of our hospitals are equipped and staffed to provide top-notch cardiac care for all conditions. Unlike other health systems, we don’t really have “flagship hospitals” for interventional cardiology that we send patients to from our other hospitals.

At St. Vincent, where I work, we can provide everything patients need. They don’t have to travel long distances to access heart care. That’s a big advantage because patients don’t have to deal with the stress of traveling on top of the diseases they’re dealing with.

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