When 84-year-old Carolyne “Dolly” Strumbel went to the Virginia emergency room on March 8, she was feeling terrible, she said, but never imagined there was anything wrong with her heart.
The next thing she knew, she was at Essentia Health-St. Mary’s Medical Center in Duluth where her symptoms — shortness of breath, weakness and atrial fibrillation — were diagnosed as a heart attack. Strumbel, who lives in Eveleth, had two coronary arteries that were 70-80% blocked.
“Next thing I know, I had stents put in my heart and I said, ‘My heart? What’s wrong with my heart?’” Strumbel said.
In order to put the stents in, interventional cardiologist Nicole Worden performed intravascular lithotripsy (IVL) on Strumbel’s left main coronary artery on March 12. IVL is a procedure that inserts a balloon into the artery and uses sonic pressure waves to break off calcium to make room for a stent.
It was the first time the procedure had been performed in the state of Minnesota since being approved by the FDA.
“I didn’t know it was going to be the first in the state until after it was done, so that’s probably good,” Worden said. “You don’t want to have that kind of pressure beforehand.”
IVL was approved by the FDA in February. Worden said the technology has been used for years in peripheral arteries, most commonly in legs, so she and other doctors were expecting the technology to eventually be used in coronary arteries using smaller balloons.
It just happened that Strumbel was the perfect patient for the procedure. Performing an open heart surgery on Strumbel posed the risk of severe complications due to her age and other medical conditions. IVL is less damaging to the arteries than the alternative of an atherectomy, which essentially uses a drill-like tool to remove the calcium.
“When she (Worden) said to me that the complication rate was significantly lower, at only 5%, it was kind of a no-brainer in that sense,” Strumbel’s daughter, Dawn Strumbel, said.
When Dolly Strumbel awoke from the procedure, she said she couldn’t even tell she’d had surgery at all.
“It just snapped me back to a normal, natural feeling and I just couldn’t believe it. It was just absolutely terrific,” she said. “I expected surgery to be a thing I would have to recover from, but it was just done and gone and fine.”
She was discharged from the hospital five days later, and is now staying at Ecumen Lakeshore for rehabilitation.
Dawn Strumbel said it was typical of her mother, who used to work as a health and physical education teacher, to do something not only for her own well-being, but for the advancement of medical treatment.
“She’s not afraid of being the guinea pig,” Dawn Strumbel said.
Worden said she was confident going into the procedure that it would work, and found that it was surprisingly easy to perform. However, she doesn’t expect IVL to be widely used in the next months or even years.
“Right now, we just have to be very choosy and make sure that we do these procedures in the right patients, and that we’re picking people who are definitely going to benefit from them because it has to be a severely calcified artery and it has to be an artery that cannot be expanded by the regular balloon,” Worden said.
In addition, IVL devices, which are exclusively produced by Shockwave Medical, cost hospitals nearly two and a half times as much as atherectomy devices, according to the Cardiovascular Research Center’s online journal TCTMD.
Worden said she doesn’t choose her methods based on cost effectiveness, but she expects that it could be a barrier for medical centers, and there isn’t yet a billing code for insurance or Medicare.
“This technology, once it becomes more mainstream, it’s going to be the beginning of a new wave of treatments for the heart,” Worden said. “This is another tool in our toolbox to deal with severely calcified arteries.”
Both Worden and Dolly Strumbel said they were impressed with the other throughout the procedure. While Strumbel didn’t anticipate going through any of this, she now feels better than ever knowing that her heart is on the mend.
“I could not believe how smooth it went and how I felt nothing and yet my heart was going to get better,” Strumbel said. “To me, it was like a miracle.”
This story was updated at 1:47 p.m. April 12 to note this is the first time the procedure was performed in Minnesota since the Shockwave technology was approved by the FDA for use in coronary arteries. Balloons for peripheral arteries have been used in coronary procedures in the past, including by Dr. Scott Mikesell at St. Luke's last winter. The story was originally posted at 3:50 p.m. April 10.