Sam’s Story

Sam’s Story: Sam’s Story: Living Heart Healthy after TCAR Living Heart Healthy after TCAR

Santo “Sam” Iacono loves life. And thanks to decades-long care at Penn Medicine Lancaster General Health — along with a steadfast commitment to healthy living — this octogenarian is more active than many people half his age.

The former owner of Sam’s Pizza, a once-iconic landmark on Columbia Avenue in Lancaster city, uses his well-honed cooking skills to prepare his own healthy meals of fish, chicken, and “lots of greens.”

He spends at least a half hour each day working out in the family room he converted to a gym, maintains his own 1-acre yard, and serves as handyman at properties he manages.

This is pretty impressive for anyone in their 80s, much less someone who has undergone quadruple bypass surgery, valve replacement, and two carotid artery procedures to prevent stroke, the most recent being a transcarotid artery revascularization (TCAR) when Sam was 82. The newer, minimally invasive TCAR procedure reduces operative risks.

What’s behind Sam’s disciplined approach to health?

“I like to live,” says Sam, who established roots in Lancaster after emigrating from Italy in the early 1960s. “I want to enjoy my kids and grandkids.”

Longstanding Relationships with Penn Medicine Lancaster General Health

Sam credits physicians at Lancaster General Health for “saving my life,” several times over. His primary care physician, Dr. William Roberts at Family Medicine Abbeyville, has monitored Sam’s health for years, referring him to specialists at The Heart Group of Lancaster General Health to treat his heart disease. Sam has been a patient at The Heart Group for more than 20 years.

From prevention and diagnosis through disease management and cardiac interventions, The Heart Group team offers the latest advancements in care, along with educational opportunities to help patients live their heart-healthiest lives. The team works collaboratively with primary care physicians like Roberts and other specialists to help ensure a comprehensive and coordinated approach to care.

Sam appreciated that Roberts was up to date throughout his treatment.

“When I went to Abbeyville for my regular checkups, it was helpful and comforting that Dr. Roberts knew exactly what I had been through and could manage my health based on the latest information,” recalls Sam. “It helped me stay on track.”

Carotid Artery Disease – Advances in Treatment

In 1997 Sam was first diagnosed with carotid artery disease — one of the leading causes of stroke in the U.S. This buildup of cholesterol plaque in one or both of the major blood vessels in the neck can restrict blood flow to the brain and lead to stroke.

Sam underwent a procedure called carotid endarterectomy to remove the plaque in the carotid artery on the right side of his neck. The surgery restores normal blood flow to the brain.

Fast forward to fall 2018 when The Heart Group’s Dr. Todd Wood, chief of cardiology at Lancaster General Hospital, discovered a blockage in Sam’s left carotid artery. This time, due to his age and the severity of the blockage, Sam was a candidate for the less invasive TCAR stenting procedure, which can be done under local anesthesia with moderate sedation.

A Team Approach to Treatment

Wood and Dr. Meghan Dermody, a vascular surgeon with Lancaster General Health Physicians Surgical Group and chief of vascular surgery and medical director of the Interventional Vascular Unit at Lancaster General Hospital, teamed up to perform the TCAR procedure.

The advanced system temporarily reverses blood flow away from the brain while a stent is inserted to open up the narrowed carotid artery. Reversing blood flow and filtering it outside the body prevents any fragments of plaque that may become loose during the procedure from entering the brain. This reduces the risk of a stroke occurring during the procedure.

The minimal dissection also decreases the risk of local nerve injury and is easier to recover from for many patients.

The Lancaster General Health Heart & Vascular Institute, which was the first in Lancaster County to offer TCAR, has successfully operated on more than 160 TCAR patients.

“We’re one of the only TCAR teams in the country to pair a vascular surgeon with an interventional cardiologist,” Dermody says. “We take kind of a tag-team approach. While I’m working on the carotid, Dr. Wood is accessing the femoral vein. It cuts down on time, which is better for the patient.”

Recovery usually takes one week, as compared to three to four weeks with a traditional carotid endarterectomy. Sam, one of the first to undergo TCAR at Lancaster General Health, was home the next day without missing a beat in his active life.

“I’m a walking miracle,” he smiles, as he approaches 10 minutes on his treadmill … not winded at all.

Article courtesy of the Heart & Vascular Institute at Penn Medicine Lancaster General Health.