March 8, 2021 by John Fernandez
New Approaches Advance the Treatment of Life-Threatening Blood Clots
Michael Metzger, M.D., interventional cardiologist at Bethesda Hospital, was the first physician at Baptist Health South Florida to utilize advanced systems to treat pulmonary embolism (PE), and acute and chronic lower extremity deep vein thrombosis (DVT).
These new treatments — Inari Medical’s FlowTriever System for PE and ClotTriever System for DVT — enable Dr. Metzger to resolve clot burden via a minimally invasive catheter-based approach, greatly reducing the risk of bleeding and shortening the patient’s hospital stay. South Florida resident Sandy Siller was among his first patients to receive these therapies.
“Dr. Metzger removed dozens of life-threatening blood clots from my lungs using these systems,” said Ms. Siller, age 62. “Needless to say, I am thrilled that he was skilled in these procedures and Bethesda Hospital had this advanced technology. I would not be here to share my story without this intervention. I am forever grateful.”
Dr. Metzger explained the benefits of these revolutionary systems. “FlowTriever and ClotTriever open the door to an entirely new approach to the treatment of pulmonary embolism and deep vein thrombosis. They enable me to intervene quickly while eliminating the risks and complications associated with thrombolytic agents. It is very rewarding to offer these potentially lifesaving techniques to our patients.”
Deep vein thrombosis occurs when a blood clot forms in one or more of the deep veins, usually in the legs, abdomen or pelvis. The condition can be very serious as these blood clots can break loose, travel through the bloodstream and lodge in one or more pulmonary arteries in the lungs. The resulting pulmonary embolism can block blood flow in the lungs and compromise a patient’s oxygen levels and heart function, potentially leading to acute heart failure, acute respiratory failure as well as sudden cardiac death.
For many years prior to the development of FlowTriever and ClotTriever, the first line of defense for blood clots was to prescribe a blood thinner called heparin to decrease the body’s ability to form clots. While this therapy may prevent a clot from getting larger, it does not dissolve the clot, explains Dr. Metzger. For massive DVTs and PEs, medications called thrombolytics, or “clot busters,” are often administered. However, these “clot busters” are used cautiously as they can cause serious and even fatal bleeding complications. The FlowTriever and ClotTriever procedures are particularly beneficial for patients who are already at risk for bleeding and cannot tolerate thrombolytic drugs.
‘I Thought I was having a Stroke’
Dr. Metzger describes Ms. Siller’s pulmonary embolism as a “prelude to sudden death.” She arrived to the Bethesda Hospital Emergency Department after collapsing in her kitchen while having her morning coffee. “When I woke up, I slithered across my kitchen floor to reach my phone and call for help. I thought I was having a stroke,” the new grandmother recalled. “Despite the urgency of my condition when I arrived in the ER, Dr. Metzger had a calmness and confidence that put me at ease. He and the entire staff at Bethesda – from the ER to the cath lab – were extremely professional and compassionate.”
Over a period of several days, Dr. Metzger performed three procedures to remove clots from Ms. Siller’s lungs (with the FlowTriever) and leg (with the ClotTriever) and place a stent in her iliac vein. “Her case was very dramatic,” he explained. “As I removed the clots and alleviated the obstructions during the PE procedure, we could detect through her vital signs immediate relief of the strain on her heart and improvement of her oxygen level. This was accompanied by acute and dramatic symptomatic relief. She is very lucky. She was in the hospital for about a week following the procedures and now, a few months later, feels incredible with no ill effects.”
‘I’m Able to be More Active Again’
Another lucky patient successfully treated by Dr. Metzger is Jay Cardieri, age 44. Although Mr. Cardieri had been taking a blood thinner following a heart attack, a chronic DVT in his leg had caused non-healing, ulcerous wounds to form on his ankle and foot.
Over a period of four years, Mr. Cardieri visited several vascular specialists who attempted to resolve the chronic total occlusion. Those attempts were unsuccessful. One physician even told Mr. Cardieri that he may have to have his foot amputated. He was bound to wound care centers for chronic debridement; however, the wounds continued to progress.
“I was in a lot of pain and my mobility was limited,” recalled Mr. Cardieri, a physician practice office manager. “My quality of life was deteriorating and I was hitting a state of depression. But Dr. Metzger was relentless to achieve a resolution for my problem.”
“Jay was considering traveling to New York or Washington, D.C. for treatment, but I offered and convinced him to have one more attempt here in Florida, with me doing the procedure,” said Dr. Metzger. “I used a combination of wires and catheters, tunneling and tracking through the clot. It takes a specialized skill set to resolve this type of chronic total occlusion. It was definitively one of the most gratifying procedures I’ve ever performed.”
For Mr. Cardieri, the procedure was a life-changing event. He explained, “My chronic leg pain was immediately relieved, my wounds are now healing and I’m able to be more active again.”