New Ultrasound Technology Saves Pulmonary Embolism Patient

EKOS system rushed from two states to Genesis

Merle Davis’ condition was rapidly deteriorating. 

Merle Davis, EKOS patient

A first in Iowa procedure – Cardiologist Nicolas
Shammas, M.D, talks Monday with a much-healthier
Merle Davis of Bettendorf, four days after new
cutting-edge ultrasound technology was used to
save his life. The patient had a submassive
pulmonary embolism that caused the right ventricle
of his heart to more than double in size.

A large pulmonary embolism in his lungs was straining his heart, causing the right ventricle to more than double in size. The blood clot had spread to both lungs like the branches of a tree, sending a shower of deadly clot material throughout his lungs.

“His lungs were filled with clots. When I saw the size of his right ventricle, I wasn’t sure how he was still alive,” says his cardiologist Nicolas Shammas, M.D., Cardiovascular Medicine, P.C.

With no time to waste, Dr. Shammas was faced with no easy treatment alternative: His patient had a submassive pulmonary embolism, a condition that carries a 1 in 3 chance of death. After several days on blood thinners, Davis was only getting worse; his breathing had grown significantly more labored. Surgery was impossible because the clot had hit the branching of the pulmonary artery and spread into pieces throughout the lungs.

Complicating his patient’s condition was the fact that Davis had recently had knee surgery, and the risk of hemorrhaging at the surgical site was too high to put him on a full-strength dose of the intravenous blood thinner TPA.

A new cutting-edge treatment – the EKOS EkoSonic ® Endovascular System that generates ultrasound energy via a catheter to soften the clot while also delivering a lower dose of clot-dissolving drug -- was not available at Genesis Medical Center, Davenport or anywhere else in the Quad Cities region.

Lifesaving endeavor

What transpired on April 10 was a life-saving endeavor made possible by the tenacity and talent of Dr. Shammas; the compassionate and quick decisions of five Genesis leaders; and, the willingness of two company representatives to get in their cars and rush two EKOS machines – one from Minnesota and the other from Indiana -- to Davenport, Iowa.

The procedure happened about 8 p.m. that same day, and Dr. Shammas became the first in Iowa to use the EKOS technology in the lungs. A week later, Merle Davis is much healthier and grateful for the extraordinary efforts made on his behalf.

“I was in ungodly pain,” Davis of Bettendorf recalls four days later from his Genesis hospital bed. “A hundred other doctors wouldn’t have dedicated the time or the effort to get this technology and make this procedure happen. When things took a turn for the worse, I had no doubt I was in the best hands I could be in. The stars lined up for me that night.”

Dr. Shammas credits his patient for his willingness to try the new technology, which he hopes will one day become a new paradigm of care at Genesis for patients with pulmonary embolism.

He also credits the support of Julie Marconi, heart and vascular director, and four Genesis administrators – Dr. Nidal Harb, Dr. Joseph Lohmuller, Dr. George Kovach and Wayne Diewald -- who escalated his request and made the quick decision to bring the EKOS to Genesis on urgent notice.

The EKOS technology was ideal for Davis’ case, making it possible to deliver one-fourth the amount of IV-administered TPA to avoid hemorrhaging while still being effective. A catheter is placed in the lung at the same time an ultrasound wire sends high beam sonic waves that soften the clots and make them easier to absorb the clot-busting medicine.

“The EKOS ultrasound technology allowed us to transform the clot, making it like a sponge with tiny holes that could receive the clot-busting drugs,” Dr. Shammas explained. “The drug gets sucked deep into the clot to accelerate its effectiveness and can dissolve it more efficiently using a reduced dose of TPA.

“In Mr. Davis’ case, the reduced dose of TPA was imperative because he had recently had surgery and was at higher risk of hemorrhaging. With EKOS, we were able to reduce the dose of TPA to 25 percent the full dose, drastically reducing his chances of bleeding.”

There were two catheters, each threading their way deep into a lung. Each had to be hooked up to a different EKOS EkoSonic ® Endovascular System – one from Indiana brought by company representative Debbie Litchfield and one from Minneapolis delivered by Roy Hosek. Dr. Shammas made the urgent call, and the systems were personally delivered that very same day.

“Within 48 hours after the procedure, Mr. Davis was already breathing a lot better,” Dr. Shammas said. “His heart rate was much improved. His right ventricle had shrunk by half, and so did the pressure inside his lungs. He went from severe pulmonary hypertension to mild.”

Dr. Shammas added, “We think this new technology is a keeper.”

“It’s got my vote!” Davis concluded.

- By Linda Barlow, Genesis

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