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 usingthese systems,” said Ms. Siller, age 62. “Needless to say, I am thrilled thathe was skilled in these procedures and Bethesda Hospital had this advancedtechnology. I would not be here to share my story without this intervention. Iam forever grateful.” 

Michael Metzger, M.D., interventional cardiologist at Bethesda Hospital

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.”

Deepvein 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 theseblood clots can break loose, travel through the bloodstream and lodge in one ormore pulmonary arteries in the lungs.   The resulting pulmonary embolism can blockblood flow in the lungs and compromise a patient’s oxygen levels and heartfunction, potentially leading to acute heart failure, acute respiratory failureas well as sudden cardiac death.

Formany years prior to the development of FlowTriever and ClotTriever, the firstline of defense for blood clots was to prescribe a blood thinner called heparinto decrease the body’s ability to form clots. While this therapy may prevent a clotfrom getting larger, it does not dissolve the clot, explains Dr. Metzger. Formassive DVTs and PEs, medications called thrombolytics, or “clot busters,” areoften administered. However, these “clot busters” are used cautiously as theycan cause serious and even fatal bleeding complications. The FlowTriever andClotTriever procedures are particularly beneficial for patients who are alreadyat risk for bleeding and cannot tolerate thrombolytic drugs.

‘IThought 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 inher kitchen while having her morning coffee. “When I woke up, I slitheredacross my kitchen floor to reach my phone and call for help. I thought I washaving a stroke,” the new grandmother recalled. “Despite the urgency of mycondition when I arrived in the ER, Dr. Metzger had a calmness and confidencethat put me at ease. He and the entire staff at Bethesda – from the ER to thecath lab – were extremely professional and compassionate.”

Over a period ofseveral days, Dr. Metzger performed three procedures to remove clots from Ms.Siller’s lungs (with the FlowTriever) and leg (with the ClotTriever) and placea stent in her iliac vein. “Her case was very dramatic,” he explained. “As Iremoved the clots and alleviated the obstructions during the PE procedure, we coulddetect through her vital signs immediate relief of the strain on her heart andimprovement of her oxygen level. This was accompanied by acute and dramaticsymptomatic relief. She is very lucky. She was in the hospital for about a weekfollowing the procedures and now, a few months later, feels incredible with noill effects.”

‘I’m Able to beMore Active Again’

Using a combination of wires and catheters, Dr. Metzger resolved a debilitating chronic total occlusion in Mr. Cardieri’s leg.

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 offour years, Mr. Cardieri visited several vascular specialists who attempted toresolve the chronic total occlusion. Those attempts were unsuccessful. Onephysician 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 woundscontinued to progress.

“I was in a lot ofpain and my mobility was limited,” recalled Mr. Cardieri, a physician practiceoffice manager. “My quality of life was deteriorating and I was hitting a stateof depression. But Dr. Metzger was relentless to achieve a resolution for myproblem.”

“Jaywas considering traveling to New York or Washington, D.C. for treatment, but I offeredand 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 andtracking through the clot. It takes a specialized skill set to resolve thistype of chronic total occlusion. It was definitively one of the most gratifyingprocedures 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.”