Ohio State Now Offering Stenting for Coronary Chronic Total Occlusion
Procedure Offers Quality of Life Improvements for Select Patients
Ohio State now offers percutaneous coronary intervention (PCI) for people with chest pain or shortness of breath due to coronary chronic total occlusions (CTOs) of three months or more in coronary arteries.
A more complex version of a standard angioplasty and stent placement, the procedure offers an important option for patients who are symptomatic and have failed medical management, had previous coronary bypass surgery or have high-risk anatomy.
“Our goal is to get people feeling better — if we can get vessels re-opened, people can have a much better quality of life,” says interventional cardiologist Ernest Mazzaferri Jr., MD, FACC, FSCAI, medical director of Ohio State’s Richard M. Ross Heart Hospital.
The specialized PCI procedure focuses on opening a total occlusion in one of the three major coronary arteries, with blockage resulting either from an acute event or gradual closure.
Candidates for the procedure are those with symptoms such as angina, shortness of breath or other signs of heart failure who have not responded to medical management. They may have had a heart attack in the past. In addition, they are unable to have coronary bypass surgery because they have already had a previous surgery, the area of blockage is difficult to reach through surgery or the patient is a high surgical risk.
Patients being evaluated for a CTO PCI often undergo a stress test or viability study and typically have a heart catheterization before the procedure to locate the blocked coronary vessel and plan the upcoming procedure.
During the CTO PCI procedure, catheters are inserted into arteries at the wrist and groin, and dye is injected into both sides of the heart simultaneously to pinpoint where stents should be placed.
“The challenge is getting through the occlusion with a rotational atherectomy device or a special catheter or wire to get though the blockage,” Dr. Mazzaferri says.
Once the CTO is open, the procedure continues like a regular stent procedure with a balloon and stent placement. Because the procedure is highly complex, involving multiple vessels, the rate of complication due to bleeding or tearing of a vessel is about 10 percent — higher than the 1 percent complication rate with a standard catheterization.
Both physician and patient weigh potential benefits against possible complications before proceeding with the procedure. Dr. Mazzaferri has been able to open blocked vessels in close to 90 percent of his cases. Less than 10 percent of people have a blockage recur.
“A third of our patients feel better right away. For some, it may take a while longer,” Dr. Mazzaferri comments.
Dr. Mazzaferri has performed thousands of standard stent procedures and views the CTO PCI as an advanced level of that work. He attended a training course at Columbia to use the equipment and techniques required for the procedure. He performs the CTO PCIs with an interventional fellow and a team of specially trained catheterization lab nurses and radiation technicians.
“For really tough cases, we’ll bring in a proctor with more experience to assist us,” he says.
“I get a lot of gratification from doing this procedure and helping people we weren’t able to help before. As improvements evolve throughout the cardiac community, complications will go down and success will go up.”