Advanced Procedure to Open Fully Blocked Coronary Arteries a Game Changer

Lehigh Valley Heart and Vascular Institute among elite programs offering CTO PCI

By Joe Nixon

Interventional cardiologists at Lehigh Valley Heart and Vascular Institute are among a tiny percentage of doctors in the U.S. with expertise on the full range of options to open chronic total occlusions (CTO).

“There are only a few places in the country that do the volume we do with the success we have. It’s a highly specialized procedure.” - Chirdeep Patel, MD

A CTO is a coronary artery that’s been fully blocked for at least three months. Restoring the blocked blood flow is done through a percutaneous coronary intervention (PCI), a balloon angioplasty with stenting, the same procedure commonly used with less severe blockages. However, getting through or around a full, sometimes rock-hard, blockage is what sets CTO PCI apart. It’s a much less invasive procedure than coronary artery bypass surgery, and for patients for whom conventional bypass surgery is not an option, it can offer relief from chest pain, shortness of breath and other symptoms.

With CTO PCI, doctors have a range of options to restore blood flow, says cardiologist Chirdeep Patel, MD, of the Heart and Vascular Institute. “There are only a few places in the country that do the volume we do with the success we have,” he says. “It’s a highly specialized procedure.”

Chirdeep K. Patel, MD

Cardiology

Interventional Cardiology

Dr. Patel says cardiologists use a variety of catheters and wires to get across the blockage. Like taking a detour off the turnpike, they sometimes use side roads to get to their destination. Often, if one coronary artery is completely blocked, the other coronary arteries will produce smaller collateral blood vessels to compensate. Heart and Vascular Institute doctors can sometimes use these newer blood vessels as alternative routes to access the blockage from the back side, where it is sometimes softer.

In other cases, doctors may need to bypass the blockage by going through the artery wall at the blockage site.

Did You Know ?

According to the National Institutes of Health, chronic total occlusions are found in roughly 30 percent of patients who have had a diagnostic coronary angiography, also known as cardiac catheterization. The true level in the general population is unknown, however, because patients who have no or minor symptoms may never have the test.

Dr. Patel says the Heart and Vascular Institute has a 75%-80% CTO PCI success rate. “There are about 20 percent we can’t open up,” he says.

Dr. Patel feels the procedure is under-prescribed and says the Heart and Vascular Institute is looking to help patients, regardless of whether they live in the geographic region served by Lehigh Valley Health Network. “These are human beings who need our help,” he says.