March 8, 2019

Patient Receives Stents and Bypass – a UAMS First

Drs. Molavi and Tobler

Drs. Tobler and Molavi

Patricia Ernst questioned her heart surgeon, UAMS’ Gareth Tobler, M.D., when he proposed a unique solution to blockages in three of her coronary arteries.

“Do you mean I’m going to be a guinea pig?” Ernst asked before being reassured that her treatments at the University of Arkansas for Medical Sciences would be in her long-term best interest.

Traditionally, Ernst, of Jacksonville, would have received three heart bypasses by Tobler. Instead she received a rare hybrid: two stents inserted by UAMS cardiologist Behzad Molavi, M.D., and one bypass by Tobler, a cardiothoracic surgeon.

The hybrid approach ensured that each of the three blood vessels received the very best treatment possible. Of the three blood vessels, an arterial graft (bypass) was best for one of them and angioplasty (stent) was best for the other two clogged arteries.

The two procedures performed in October marked the first time a patient at UAMS has received both stents and a bypass. A stent is a wire mesh tube that holds arteries open to improve blood flow. Rarely do patients have a cardiologist and cardiothoracic surgeon working in concert to offer both procedures, Tobler said.

“The reason is that surgeons perform bypasses and cardiologists perform the stent procedures, and patients almost always get one or the other,” said Tobler, who performed Ernst’s bypass. “Surgeons and cardiologists also work in different places, we’re trained in different ways, we have different approaches to treatment, and working together is not so common.”

But Tobler and Molavi have worked to remove those barriers, with enthusiastic support from David Rutlen, M.D., director of the UAMS Division of Cardiovascular Medicine.

“This is the first time for a patient to have both procedures here at UAMS, and we believe it is the first time in Arkansas,” Rutlen said. “Dr. Tobler and Dr. Molavi are really at the forefront, and this is going to mean a lot for patient care here at UAMS.”

Tobler said three heart bypasses would have worked, but that wasn’t the very best solution.

Bypassing two of the artery blockages would have required harvesting veins from another part of the body. The problem with that approach is that veins are not as long-lasting as arteries or stents, based on a growing body of research.

So Tobler contacted Molavi, and the two agreed to use the hybrid stent-bypass approach. Molavi inserted the stents and Tobler performed the bypass surgery almost immediately afterward.

“Dr. Tobler and Dr. Molavi have demonstrated that this can be done very effectively, which gives us confidence that we can do the same for any patient in the future if the situation calls for it,” Rutlen said.