Advanced interventional procedure can reverse CTO, with high success rates
If your patient has been diagnosed with chronic total occlusion (CTO), but treatment has been unsuccessful or unavailable, Tulane’s interventional cardiologists may be able to help. Thanks to their advanced training and extensive experience treating people with complex CTO, they have successfully reversed symptoms and improved cardiac function among many patients who thought they had run out of options.
Limited options have left many without treatment
As a physician, you’re well aware that advanced coronary artery disease poses significant health risks – and can be difficult to treat.
CTO in particular has presented challenges for even the most experienced interventional cardiologists. Because the artery is 100 percent blocked, and often reinforced by calcified or fibrotic tissue, it may be difficult or impossible to cross through the artery. In these cases, standard angioplasty and stenting techniques – which are most successful in cardiac patients with partial blockages – usually do not work.
Although physicians have historically recommended coronary artery bypass grafting (CABG) as an alternative for patients with CTO, a significant number of people are considered too high-risk for open heart surgery.
These circumstances have left a subset of CTO patients untreated – facing a lifetime of worsening and often debilitating symptoms that typically lead to heart attack or heart failure.
How CTO PCI combines advanced techniques to remove blockage
A game-changing procedure called chronic total occlusion percutaneous coronary intervention (CTO PCI) is helping CTO patients who have exhausted other treatment options. With success rates around 90 percent and a complication rate at the national average, the procedure is highly effective – even among high-risk patients.
What’s different about CTO PCI is that it allows physicians to approach a coronary blockage from multiple sides. This requires a combination of advanced imaging procedures (including dual injection angiography and intravascular ultrasound), emerging devices (including the next generation of tiny coronary guide wires) and refined surgical techniques.
With these tools and techniques at their disposal, interventional cardiologists are using innovative approaches to access blockages, including:
- When physicians cannot cross through the lumen due to the length of the blockage, they can dissect into the skin of the artery, specifically entering the space between the intima and media (the middle and outer layers of tissue). After traveling through this space within the artery wall, they can re-enter the artery downstream and place stents before and after the blockage. Over time, the artery will develop new cells that cover the stents, essentially creating a percutaneous bypass inside the vessel.
- Using a hybrid approach that may involve both antegrade (forward moving) and highly specialized retrograde (backward moving) techniques, physicians can access an occlusion by traveling through the small collateral blood vessels that developed to reroute blood flow around the blockage. This network of collateral vessels allows doctors to cross from one side of the heart to the other and enter the blocked artery from multiple sides.
Expanding access to CTO PCI
Although CTO PCI has an impressive track record, the procedure is still not widely available.
Tulane Medical Center physicians Nidal Abi Rafeh, MD, and Owen Mogabgab, MD, are among the two percent of interventional cardiologists in the U.S. currently qualified to perform the full range of CTO PCI procedures, including retrograde approaches. They have received specialized training beyond their interventional cardiology fellowships, studying under world renowned physicians who helped pioneer the treatment.
As one of the few hospitals in the country to offer CTO PCI, Tulane Medical Center is accepting referrals from across the Gulf South region and beyond.
To expand access to this advanced procedure for patients not able to come to New Orleans, Tulane physicians travel to other U.S. hospitals to train their peers and proctor cases in the cardiac catheterization lab. To date, our interventional cardiologists have proctored CTO PCI procedures in Florida, Alabama, Mississippi, Texas and elsewhere in Louisiana.