CTO Chronic Total Coronary Occlusion (CTO) Program
Technological advances for treating 100% chronically occluded coronary arteries are enabling numerous Deborah patients to avoid open heart bypass surgery, and have given them a new lease on life. Deborah’s Chronic Total Coronary Occlusion (CTO) Program uses novel tools and techniques to approach CTOs and is achieving significant procedural success rates in crossing and opening these complex lesions.
In conjunction with new technologies such as the CrossBoss™ and Stingray™ Coronary CTO Crossing and Re-entry System, the only FDA-cleared devices for use in CTOs—Deborah’s program offers a fresh approach to these complex cases, especially for those considered too risky for bypass operations or with anatomy not technically amenable to bypass surgery, and for those others whose surgical bypass grafts have also become occluded.
With these new technologies in place, along with Deborah’s specialists’ rigorous training in the techniques required to use these technologies, the hospital’s interventional cardiologists are now able to create a new pathway for the treatment of completely blocked arteries. These new devices are able to either move directly through the occlusion, or—if the blockage is too hard— to go around the blockage by entering the deeper layers of the arterial wall, using additional technology to reenter the open blood vessel beyond the blockage, thus creating a successful avenue for blood to flow around the blockages. Alternatively, these 100% blockages can be crossed in reverse by advancing special wires and devices through collateral channels arising from other open vessels that connect with the totally blocked artery.
“These new devices and techniques require an extraordinary amount of training and skill. Chronic total occlusions previously had limited treatment alternatives beyond medical management or surgery, and we are thrilled to finally have a new approach for treating this condition.”
Richard Kovach, MD, Chair, Interventional Cardiology and Medical Director of the Catheterization Laboratory.
Radial Artery Harvesting
Rather than using the saphenous vein from the leg for bypass grafting, the radial artery from the arm is harvested and used. The radial artery resists the atherosclerotic process more than the saphenous vein. The arm suffers no ischemia with the removal of this artery because the blood supply to the hand is assessed preoperatively in selected patients.
Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)
MIDCAB is bypass surgery that is done without stopping the heart and placing the patient on a heart/lung machine. The surgery is performed through a four inch incision. This procedure is applicable for single bypass grafts to the LAD.
Cryoplasty For many patients with vascular disease, walking one city block is impossible. The pain in the legs and feet associated with vascular disease is often unbearable; the patient must stop and rest to relieve the pain, which returns upon resumption of exercise. The balloon angioplasty procedure does not always offer long-term success in the legs, especially in the femoral artery in the thigh. For reasons still unknown to physicians, this artery is prone to renarrowing after interventional procedures to open it – as many as 60 percent of patients will experience reoccurring blockages. Stents, which could help support the artery walls, are not a desirable option in this artery because scar tissue is highly likely to form within the stent, causing further blockages. Bypass surgery is costly and invasive, and grafts to this artery are prone to occlusion themselves. Often, vascular disease patients have no option for bypass surgery because the saphenous vein has been used previously to bypass the coronaries.
Impella LP 2.5 Heart Pump with the Stereotaxis Remote Navigation System for Treating V-Tach Ablations
Deborah physicians have expanded its use of the Stereotaxis Remote Navigation System (which is able to provide a flexible, robotically-driven catheter ablation to delivers radiofrequency energy to destroy small areas of heart tissue responsible for the arrhythmia) in combination with the Impella LP 2.5 heart pump. This allows ablation treatment for patients with advanced heart damage and heart failure who were not previously considered for the Stereotaxis Magnetic Navigation System procedure. The use of the Impella LP 2.5 heart pump -- the world’s smallest heart pump -- provides the heart with active support in critical situations, pumping up to 2.5 liters of blood per minute -- flowing continuously from the left ventricle into the ascending aorta -- allowing for critically-needed intervention care.
In the US each year, 800,000 people undergo coronary angioplasty to open narrowed and/or blocked arteries. More than 80 percent of these patients will receive stents; however, within six to nine months, many of these patients will experience in-stent restenosis due to scar tissue build-up, which could require them to undergo additional interventional or surgical procedures. Drug-eluting stents, when used during angioplasty, offer effective reduction of restenosis by emitting a controlled-release drug for several weeks after the procedure.
In-stent restenosis has posed a challenge because the probability of recurrent restenosis in previously stented patients is 40-80%. Though some therapies exist to treat in-stent restenosis once it occurs, until now, no methods were available to limit it.