Vascular Center Medical Director John Laird performed a carotid artery stenting on Norah Dean, while a video and audio feed of his actions and other proceedings in the cardiac catheterization suites was transmitted, live, to about 2,000 participants at the 2008 Vascular International Advances (VIVA) conference in Las Vegas, Nevada.

When Norah Dean came to UC Davis Medical Center recently to have blockages in her carotid arteries removed, the experimental procedure used by Vascular Center Medical Director John Laird was not the only unusual aspect of her visit.

As Laird performed a carotid artery stenting on Dean, a video and audio feed of his actions and other proceedings in the cardiac catheterization suites at UC Davis Medical Center was transmitted, live, to about 2,000 participants at the 2008 Vascular International Advances (VIVA) conference in Las Vegas, Nevada.

UC Davis was one of only five vascular centers across the United States selected to host live-case demonstrations.

The other institutions selected to present live cases were the Cleveland Clinic, Presbyterian Heart Institute, in Dallas, Texas; Greenville Memorial Hospital, in Greenville, S.C.; and the University of Illinois Francis Medical Center, in Peoria, Ill.

Their cases were transmitted to VIVA attendees gathered at the Wynn Las Vegas hotel. As the physicians performed their procedures, panels of nationally recognized experts commented on the cases as they proceeded, offering critiques and praise, and asking questions. The experts were able to speak directly to the physicians at their remote locations.

“I wasn’t bothered one bit. I was excited about the chance to teach other doctors and show them new procedures.”
—Patient Norah Dean, when she learned that her case would be viewed, live, by about 2,000 attendees at the VIVA conference

The VIVA conference is a national education course for vascular intervention and medicine, and attracts physicians from around the world in such specialties as interventional cardiology, interventional radiology, vascular medicine, vascular surgery, cardiothoracic surgery, neurosurgery and neuroradiology. The live cases provide attendees with the opportunity to observe optimal techniques performed live and in real time.

At UC Davis, five cases were presented over two days of the conference, on Sept. 23 and 24. In addition to Laird, David Dawson, professor of surgery, Jason Rogers, associate clinical professor of cardiology, and Jeff Southard, assistant clinical professor of cardiology, worked on cases.

Michael Dake, a professor of cardiothoracic surgery at Stanford University and a moderator of one of the VIVA panels of experts, praised UC Davis’ role in the conference.

“I was very impressed by the performance and professionalism of the team,” Dake said. “The quality and complexity of the cases were first-rate. From the standpoint of the complexity of the cases, their educational value was unparalleled to the conference attendees.”

The stenting procedure used by Laird has limited approval by the FDA for certain high-risk patients, but Dean was treated as part of an experimental protocol. The procedure is part of several ongoing research studies being conducted by the Vascular Center to assess different ways of performing carotid artery stenting.

Of the five institutions invited to participate in VIVA, the UC Davis Vascular Center was the most active, presenting four cases on the first day of the conference, and two on the second.

When Dean, 71, learned that her case would be viewed, live, by about 2,000 attendees at the VIVA conference, she said, “I wasn’t bothered one bit. I was excited about the chance to teach other doctors and show them new procedures.”

Dean’s physician in Vacaville referred her to Laird after he performed a screening examination that revealed one carotid artery was 99 percent blocked, while the other was 70 percent blocked. When Laird treated Dean, he found that the artery thought to be 70 percent blocked actually had a blockage of 80-plus percent.

Dean said she was “shocked” at the severity of the blockages, as she had never felt any symptoms from the condition.

Nevertheless, the state of Dean’s carotid arteries gave her a highly increased risk of stroke, Laird said, and the main reason for treating severe carotid blockages, either through surgery or stenting, is to reduce the risk of stroke.

The stenting procedure used by Laird has limited approval by the FDA for certain high-risk patients, but Dean was treated as part of an experimental protocol. The procedure is part of several ongoing research studies being conducted by the Vascular Center to assess different ways of performing carotid artery stenting.

The established way of treating carotid artery blockages is a surgical procedure known as cardiac endarterectomy. Carotid artery stenting is a less-invasive method, as it requires no incision in the neck, and thus presents a reduced risk of cardiac complications or complications from anesthesia. In this procedure, a physician reaches the carotid arteries via an artery in the groin, through a puncture made in the skin. The same approach is used in cardiac catheterization procedures and coronary stenting.

In Dean’s case, Laird and his team treated not only her carotid artery blockage, but a blockage in the major artery under her left shoulder, which was impeding the flow of blood to Dean’s arm.

When she later learned the severity of her artery blockages and the extensive calcification in her arteries, Dean said, “That was a shocker. Dr. Laird said it was like cement.”

As for the procedure, Dean said, “It was a piece of cake. I didn’t feel anything.”