Five questions with Dr. Sonal Pruthi, Interventional Cardiologist and Endovascular Specialist
We spoke with Sonal Pruthi, MBBS, about joining the faculty at Columbia’s Interventional Cardiovascular Care program and her role developing and expanding endovascular services in Goshen, NY.
What made you decide to become a cardiologist?
I grew up in a small town in India, where there were no good opportunities for higher education. Despite this, my parents were very keen on their kids getting a good education, and they sent me to Delhi, where I completed my higher education and then went on to medical school.
My uncle was a physician in the USA, and talking to him made me realize the value of an advanced health care system. So, I decided to come to the US to complete my specialized training.
During my residency, cardiology had always drawn me in. I enjoyed the diagnostic challenges, the patient interaction, and the meaningful difference you can make in someone's life with timely interventions. So, I went on to do my cardiology fellowship at the University of Connecticut Hartford Hospital and then to train further in Interventional cardiology at NYU. While I love coronary procedures, I realized that to provide a holistic approach, I wanted to train in vascular medicine and interventions. So, I decided to do a peripheral fellowship, which I completed here at Columbia.
Can you tell us about your role here at Columbia?
I am an endovascular specialist, meaning I treat conditions affecting the blood vessels – both in the heart arteries and the vessels outside of the heart. I do both arterial and venous procedures in the endovascular space. The arterial procedures include dealing with blockages in the arteries of the abdomen, legs, kidneys, and carotid arteries (brain). In the venous space, we do procedures to deal with blood clots in the leg and blood clots called pulmonary embolisms that travel to the lungs and block blood flow there.
One area that I am passionate about is spreading awareness regarding optimizing therapy for limb salvage. Some patients have disorders affecting the arteries in the legs and need amputation.
I think a lot of people get amputations without having a complete understanding of the bigger picture. For example, if the toe is dead, it needs to come off, but we have to do whatever we can to ensure that the amputation does not need to go from the toe to the ankle and the knee. So, before we proceed with the amputation, it's critical that we perform baseline imaging to see what the blood flow is doing. It doesn't have to be an invasive procedure; you can start with an ultrasound. But everybody needs an assessment of the circulation, and if there's something we can do to improve the circulation, we have that opportunity.
I understand you can't fix all the blockages in the leg. Not only does it not help, you're increasing the risk of complications. But whatever blood flow you can safely restore, the better the chances are of giving a wound what it needs to heal. And if the limb is not salvageable, then at least the amputation can properly heal, and we can prevent additional amputation further down the line.
That's one area I strongly feel about because that step is often missing. Many of these patients—especially people who have diabetes or kidney disease—have concurrent neuropathy where they don't feel the wound, so they don't realize what's going on with the wound. So, we need to determine if the wounds are circulatory or not.
And procedures are just one aspect of their care. In my experience, many of these patients are not on the right medicines. That's why we also see these people in our office and follow them for their vasculature.
I see patients in my outpatient practice in Goshen, NY, as part of Columbia's partnership with Garnet Health, and it is a great privilege to be able to provide these services.
What research are you involved with?
Peripheral arterial disease—blockages in the arteries outside of the heart, mainly in the legs— has been the subject of research, but that research has not been focused on women. We know that women behave a little differently in terms of how their arteries are affected by calcification. We don't have enough data to know if we should be doing the same procedures or using the same type of technology. So, my main research focus will be women and PAD.
Columbia is a great place to be for research, and PAD is no exception. We're participating in several PAD trials, and we take part in a number of registries for drug-eluting technologies—like drug-coated stents and balloons.
We actually have an article coming up for Vascular Month in an ACC journal about disparities in PAD. But it's more than that. We need to do more about disparities in general, not just women. We're realizing that even though the disease process is the same, and most of the technologies work for most people, the nuances that come with different demographics affect the quality of care.
For example, African Americans might not respond to the same blood pressure medicines that we know Caucasians respond to. The same goes for women. So, we need the critical competence to realize that we don't have enough data, and we need to avoid saying that this will be a blanket therapy for everybody.
What's next for endovascular treatments?
There are three developing areas in the endovascular space that I'm particularly excited about. One is how we're addressing peripheral arterial disease - especially for arteries below the knee - these arteries are not as amenable to surgical techniques because they're so small. Many people with diabetes and kidney disease have blockages in the arteries above the knee, but they also have a lot of disease in the arteries below the knee. As I said, we don't try to fix everything but fix what we can to improve blood flow.
Another exciting area is upcoming therapies for treating pulmonary embolisms. It is a rapidly growing space, and several technologies have evolved over the last five years, which are both exciting and hold a lot of promise in terms of improving outcomes.
The third area is renal denervation for patients with high blood pressure. The kidney arteries are responsible for regulating not just the kidneys but the hormones and nerves around them. Denervation is a minimally invasive procedure where we use ablation to burn the nerves just enough that they don't respond as aggressively. In a select population of patients with hard-to-control BP despite aggressive medical therapy, renal denervation has shown promising results.
How has your experience with Columbia been so far?
Columbia has established itself as one of the premier centers with a team of dedicated clinicians and researchers. Every day at work, you interact with astute, skilled clinicians who go above and beyond for their patients. For both personal and academic growth, I think once you're involved with teaching and research, you keep up to date and grow as a clinician—you have to keep learning. And when you keep learning, you're better positioned to know what you can offer your patients.
The system is collaborative, wherein multiple specialists come together seamlessly to ensure the best outcome for the patients. At the same time, these clinicians are renowned researchers expanding the growing frontiers of cardiology, and it is an honor to be working here.