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New Heart and Vascular Institute Capability Offers Hope for Complex Cardiac Blockages

Improved techniques and equipment have boosted success rates

Left: Chronic total occlusion of coronary artery. Right: Same patient, but with successful opening of CTO.

Picture this: An individual comes into a doctor’s or clinician’s office with symptoms of chest pain, shortness of breath and fatigue. The doctor or clinician orders a cardiac catheterization procedure, which reveals that one artery has a 100 percent blockage.

Nothing to be done. End of story, end of treatment. Right?

Not anymore, says Chirdeep Patel, MD, interventional cardiologist at Lehigh Valley Heart and Vascular Institute.

“If a patient has been told, ‘You have a blockage but there’s nothing we can do about it,’ chances are it’s chronic total occlusion,” Dr. Patel says. “And, more importantly, chances are that the statement, ‘There’s nothing we can do about it,’ is inaccurate. Almost always, there’s something we can offer this patient to help them feel better.”

Newer techniques, better success rates

Chronic total occlusion (CTO) is common, Dr. Patel says: “About 25 to 30 percent of patients who undergo a cardiac catheterization procedure have CTO.” CTO is a complete or near-complete blockage of one or more coronary arteries.

For less blocked arteries, the decades-old remedy is to use a balloon angioplasty and a stent to open the valve. But CTO presents a unique challenge. “When arteries are totally occluded, trying to open them become exceedingly difficult,” Dr. Patel says.

Until recently, success rates of angioplasty-and-stent procedures for people with CTO were only around 50 percent. But, Dr. Patel says, “with newer techniques, newer catheters and newer wires, we’re able to increase that rate up to 80, 85 and 90 percent.”

And because the minimally invasive surgical method is very similar to routine balloon angioplasty and stenting, the recovery is similar, too. “Patients are up and about no more than an hour or two after the procedure,” Dr. Patel says. “A lot of our patients go home the same day.” 

The Heart and Vascular Institute difference

While the methods and recovery times of CTO procedures are similar to routine interventions, the execution is far more complex.

To create a good CTO program, Dr. Patel says, a health organization needs three things: expertise, infrastructure and equipment. At Lehigh Valley Heart and Vascular Institute, “we have it all,” Dr. Patel says.

The Heart and Vascular Institute is the only local institute to perform this minimally invasive surgical method for CTO.

“It’s time to reassess these patients and offer them the most modern therapy that’s available to them,” Dr. Patel adds. “The procedure is safe and has a good success rate. Patients also feel much better when we’re done.”

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