New procedure could help avoid bypass surgery
You’ve just been given a diagnosis for that chest pain or abnormal stress test – it’s CTO or chronic total occlusion, meaning a heart artery that is 100 percent blocked. Immediately, you’re imagining bypass surgery, but not so fast. Thanks to aggressive techniques and advanced instruments, experienced cardiologists are now able to help some CTO patients avoid the knife.
“We are doing everything we can,” says Dr. Thomas Levin, an interventional cardiologist at Advocate Christ Medical Center in Oak Lawn, Ill., in regards to providing minimally invasive options for eligible patients.
Interventional (minimally invasive) heart procedures like angioplasty are performed in a cardiac catheterization laboratory where doctors make only a small incision in a patient’s groin or arm. Then they insert a catheter, threading it through a patient’s arterial system to reach the blockage in the affected artery. With the instrument, they bore through the plaque, which is impeding blood flow to re-open the artery.
Such procedures are simple enough, but, until recently, patients with totally blocked arteries often have defied treatment with standard, interventional measures. For them, minimally invasive techniques have proven only 50 percent to 60 percent effective in providing relief for their condition. In fact, diagnosis of CTO likely has meant referral of a patient to a heart surgeon.
However, the more aggressive interventional procedures now being attempted by Dr. Levin and others experienced interventional cardiologists are proving increasingly effective in eliminating extensive blockages without surgery.
“With the availability now of miniaturized technology, including specialized catheters with small guide wires, we are going into the [blocked] artery, puncturing through the extensive plaque that is obstructing blood flow, clearing the arterial channel and then placing stents inside the artery to keep it propped open,” Dr. Levin says.
When necessary, cardiologists may use a two-catheter approach to eliminate the plaque that has totally plugged the artery. The technique involves threading one catheter directly into the blocked artery to bore through the plaque at one end, while, through a second small incision, moving another catheter around the patient’s arterial system to reach the diseased artery and the blockage from the other end.
At Advocate Christ Medical Center, the success rate for treating CTO minimally invasively is as high as 80 percent to 90 percent. In addition to crediting the measures that more and more interventional cardiologists are using, Dr. Levin emphasizes the importance of careful selection of CTO patients for minimally invasive procedures in order to improve chances for a good outcome.
“Appropriate patients usually have symptoms, such as chest pain, or have an abnormal stress test, and the heart muscle normally fed by the blocked artery remains viable – alive,” Dr. Levin said. “The heart muscle can remain alive if collateral arteries continue providing it with blood. However, if the heart muscle in the area of the blocked artery is already dead, then there is no sense in trying to re-open the artery.”
Surgery still remains a better option for some patients who have multiple blocked arteries, including CTO, Dr. Levin says.
About 15 percent of patients with arterial blockages have CTO. Of these, many are potential candidates for a minimally invasive procedure. Studies have shown that successful interventional techniques to treat CTO offer patients relief of symptoms, improve the left ventricular function of the heart and increase survival rates. However these rigorous procedures can take as much as two hours to three hours to complete – about twice the time of a standard angioplasty/revascularization procedure.
Patients treated minimally invasively for CTO usually only stay in the hospital overnight.
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