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A Minimally Invasive Fix for Blocked Coronary Arteries

Providence St. Jude offers game-changing advance

About 15-20 percent of Americans with heart disease have at least one completely blocked coronary artery. Called a chronic total occlusion or CTO, the blockage typically creates symptoms of fatigue, shortness of breath or chest pain—and often makes it difficult to climb stairs, exercise or sometimes even walk to the kitchen.

Traditionally, coronary artery bypass surgery has been the only option if medical therapy failed.

Thanks to improvements in techniques and technology, a small number of medical centers offer another option: opening a 100-percent blocked artery using a minimally invasive catherization or stent procedure known as a CTO PCI (percutaneous coronary intervention).

“It gives us another tool in our toolbox for restoring a patient’s life,” explains Michael Chan, MD, a Harvard and Johns Hopkins-trained interventional cardiologist at Providence St. Jude Medical Center. Dr. Chan says potential candidates range from individuals who need bypass and prefer a minimally invasive approach, to those considered too high risk for surgery. “Watching a patient who had been told there were no treatment options left return to a full and vibrant life, is one of the best parts of my job.”

Often called “the last frontier” of interventional cardiology, a complete blockage of the coronary artery is considered one of the most challenging issues to treat minimally-invasively. Only a small number of interventional cardiologists routinely perform the procedure and even fewer are experienced in treating complex cases—the kind regularly referred to Dr. Chan from all over Orange County.

In addition to dramatically reduced pain and recovery, CTO PCI patients go home the same day or next day, eliminating the 5-8 day hospital stay typically required for bypass surgery.

The technically challenging procedure uses catheters inserted through the wrist (radial access) or groin to drill through or around the blockage, often approaching it from multiple directions. Tiny metal stents are embedded in the walls of the previously untreatable artery, serving as scaffolding to hold the artery open. If the heart has been weakened by the blockage and requires additional support, a temporary pump is inserted via catheter to allow the heart to rest. When performed at specialized centers such as Providence St. Jude, success rates approach 85-90 percent.

According to Dr. Chan, while CTO PCI is not the right option for every patient, for many it will offer an important breakthrough. “It is allowing us to flip the script from ‘go home and live with your symptoms’ to ‘give us a day and we can fix your heart,’” he says, explaining the hospital’s cardiologists, heart surgeons and interventional cardiologists collaborate to determine the best course of treatment.

CTO PCI is just one of several minimally invasive procedures being used at Providence St. Jude to change the treatment of both common and complex heart problems. TAVR, a non-surgical alternative to aortic valve replacement, and MitraClip, a minimally invasive solution for mitral regurgitation, are also routinely performed by the hospital’s interventional cardiologists.

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