Mount Sinai Patient Is First in the Nation to Receive Dissolvable Implant for Limb-Threatening Blockage of Blood Vessels Below the Knee
Patrick Curran, a former New York City police officer and a volunteer firefighter and emergency medical technician, has been living with diabetes for more than twenty years. By 2019, he started to develop ulcers, or sores, on his feet, a result of severe circulation and nerve issues related to his diabetes. Patrick’s search for options led to a new, advanced procedure at The Mount Sinai Hospital.
The first diagnosis Patrick received was a diabetic condition called Charcot foot. The condition is caused by nerve damage (neuropathy) that leads to a loss of feeling in the lower legs and feet and potentially bone fractures in the feet. Patrick’s local vascular surgeon also diagnosed a condition called chronic limb-threatening ischemia (CLTI) below the knee. This is a severe form of peripheral artery disease (PAD), a circulatory disease common among diabetics that causes narrowing and blockages in the arteries. Chronic limb-threatening ischemia prevents blood and oxygen from reaching the lower leg and foot, and causes extreme pain and open wounds that do not properly heal. In some cases, it can lead to amputation.
Over the next few years, Patrick underwent two balloon angioplasty procedures to help open up the arteries and restore blood flow to his legs and feet. This is a standard procedure where a catheter is inserted to inflate a balloon that dilates a narrowed artery. However, the effects are often temporary. After the blockages in Patrick’s arteries returned for a second time, his vascular surgeon referred him to Prakash Krishnan, MD, Professor of Medicine (Cardiology), and Radiology, Icahn School of Medicine at Mount Sinai, and Director of Endovascular Services, Mount Sinai Health System. Patrick went to see him in January 2024. “My doctor told me that Dr. Krishnan was a teacher of doctors, and that he had different tools and could probably help,” Patrick says. “I went to Dr. Krishnan, and he looked at the tests I brought, and he agreed.”
“Patrick is one of millions of Americans who suffer from peripheral arterial disease. Luckily he was diagnosed early and had been getting great care, but he was running out of options,” says Dr. Krishnan. “I knew we had cutting-edge therapies on the horizon that would help Patrick.”
Dr. Krishnan initially carried out an atherectomy, a minimally invasive procedure to remove plaque from an artery to widen it and improve blood flow. Although there was some improvement in the blood flow after the procedure, after a few weeks it became clear that the ulcers were still not fully healing—a sign that not enough blood was reaching his feet.
Dr. Krishnan suggested a new type of stenting procedure, using a dissolvable implant called a drug-eluting below-the-knee resorbable scaffold. The implant is inserted with a catheter via a small incision in the leg, where it gradually dissolves over time, allowing the artery to expand and heal independently.
“Dr. Krishnan assured me that it wouldn’t have any side effects with my own health problems,” Patrick says. “He felt that I was the perfect candidate. I said, ‘If it's going to save my leg in the future, and you'll help us save other people, let’s go for it.’”
The procedure took place on May 7, 2024, at The Mount Sinai Hospital. Dr. Krishnan and his team inserted six of the new bioabsorbable scaffolds into the blood vessel in Patrick’s leg that was providing blood flow to the wound. “Patrick is the first patient in the world outside a clinical trial to receive this scaffold system,” says Dr. Krishnan. “This provides additional clinically proven treatments to help treat patients suffering from peripheral arterial disease.”
Patrick returned for a follow-up with Dr. Krishnan a few weeks later. The ulcer on his foot was finally healing, and for the first time in many years, the medical team was able to register pulses in his feet without having to use an ultrasound test, a clear sign that the blood flow to his lower leg and foot had improved significantly. Patrick reported further improvement during a follow-up call with Dr. Krishnan in June 2024.
“The wound is definitely much smaller—he sent me photos,” Dr. Krishnan says. “It's almost closed. He's still having pain in the Charcot’s foot, but the ulcer is actually much, much better at this stage.”
Explaining his decision to be the first patient to undergo a new form of procedure, Patrick says, “I do everything I do for my family, for my kids. I want to be here for them. So, if it looks like something new might help in the long run, I believe you should go for it. And the doctors that invented this stent—it will prolong your life, the use of your legs—no amputations.”
“Arterial blockages below the knee are notoriously difficult to keep open for a number of reasons,” Dr. Krishnan explains. “There are issues with scar tissue formation within the vessel, and closure of the vessel. There have been numerous trials of new devices that have been compared with the standard of care, which is balloon angioplasty, but until now all those trials have failed. But with the study on this type of implant, the results after one year show the patency rates and wound healing rates are much superior to balloon angioplasty, and I’m expecting a very, very good outcome for patients.”
Patrick recently spent the weekend attending a wedding and is now looking forward to returning to his work as a volunteer firefighter and emergency medical technician.
Patrick has been impressed by the level of care he received from Dr. Krishnan and the team at The Mount Sinai Hospital. “The care I received at Mount Sinai was unbelievable,” Patrick says. “For Dr. Krishnan to do what he did for my life, I couldn't thank him and his team enough. And the nurses were fantastic—the best! They know their patients, and they know the care that they need.”