CTOMD for Patient
CTOs can be defined as blockages that usually prevail for more than three months, caused by the deposition of plaque or fatty deposits in the walls of arteries (atherosclerosis), which is also a part of complications due to coronary artery disease (CAD). In CAD, narrowing or blocking of the artery or arteries, which are responsible for supplying blood to the heart, occurs as a result of atherosclerosis. A person may experience chest pain (angina), shortness of breath or even a heart attack if the heart does not receive sufficient amount of blood. These symptoms could become prevalent during exertion but at times even at rest.
Traditionally, there is limited treatment options for CTO because of the complexity associated with opening up of completely blocked arteries by employing catheter-based methods. Historically, coronary artery bypass grafting (CABG) or open-heart surgery is typically recommended by the physicians, which have been the only available option for dealing with such blockages. In this surgery, an artery or a vein from a different body part is taken to open up a new route to the coronary artery, thereby bypassing the area that is blocked while opening a new path for the blood to flow. As CABG surgery is associated with high risk, it is not recommended for all patients. In a different case, certain patients may not have to undergo CABG and could suffice from stenting by employing CTO PCI techniques. In a stenting procedure, narrowed or blocked arteries are widened up by placing a small mesh tube within these arteries to support the artery walls and keep the blood flowing.
With the advent of advanced training and new cutting-edge technologies, Mass General now offers minimally invasive methods to treat CTOs with a success rate of almost 90%.
Only experienced cardiac interventionists can carry out the CTO PCI procedure; these are professionals who have received specialised training in advanced techniques to treat CTO blockages. Currently, in the United States, only 1%-2% of cardiac interventionists can carry out the full range of CTO PCI. The duration of the procedures could vary between two and five hours based on the complexity associated with these blockages. Post the procedure, the patients are admitted to the hospital overnight for further monitoring.
In the United States, Mass General is one amongst the few centres that employs a combination of retrograde (backward-moving) and antegrade (forward-moving including dissection/re-entry) approaches for accessing the blockage. A blockage results in the formation of new blood vessels, also called as collateral blood vessels, surrounding the blockage to allow blood flow. By employing advanced guide wires, a catheter is inserted by the physicians into these collateral vessels, which allows entry into the blocked artery from several sides. By employing a technique known as balloon angioplasty, at the tip of the catheter, a small uninflated balloon is placed, which is then inflated after placating within the artery. This method, along with stents, is employed to widen the openings in the arteries in order to allow blood flow.
The procedure is typically associated with a slightly increased risk for kidney damage because of the intravenous contrast used as well as bleeding near the entry site into arteries in the groin. However, majority of the other risks are alike to those observed for a more routine angioplasty and may include:
- Bleeding near the site of puncture
- Blood vessel damage near the site of puncture
- Abrupt closing of the coronary artery
- Slight tear in the artery’s inner lining
- Heart attack
CTO PCI is regarded to be a complex procedure to carry out and demands expert care from physicians with a vast experience. At Promed, specialty training has been given to the CTO PCI team regarding the procedure; they are studying under a small group of people renowned internationally as pioneers in the field.
The team includes clinicians who are considered as leaders in the field of CAD. At Promed, our physicians will work along with you, your care team as well as other experts to help inform the best course to treat your CTO. We perform a brief assessment in consultation with your primary care team to come up with a complete treatment plan that caters to your individual requirements.
Promed has been consistently placed amongst the top ranks of best hospitals. Our ranking is credited to our patient safety, quality of care and reputation earned in more than a dozen separate specialities. We work to make sure that you get the highest quality care covering all points during your visit. Our patients can reap benefit from leading research and shared expertise, ensured by our commitment to quality and excellence.
It is important that the patient is eligible before undergoing CTO PCI. The CTO clinical team will carry out a critical review of clinical data, your history and previous assessments regarding your medical and cardiac and condition to identify eligibility for CTO PCI procedure. We work closely with your cardiology, primary care and medical teams.
Should you be scheduled for a CTO PCI procedure, the following instructions need to be carried out:
- Discuss with your doctor about your allergies, medications and any other issues before commencing the procedure
- Continue with your prescribed schedule to take medications. Individual review by your physician is needed if your medications include insulin, Coumadin®, other anticoagulants, diuretics and oral diabetic medication
- After midnight, do not consume food or drink (only a few sips of water with your medication)
The afternoon before your procedure starts, a nurse will assist you from the catheterisation lab to review these instructions and will inform you on the timings to come at the lab. It is recommended that you use this chance to clarify any questions or concerns regarding your procedure.
Just before starting with the procedure, patients will be sedated like in the usual heart catheterisation procedures. The procedure starts by inserting two catheters in arteries (wrist or leg) to allow to going both forward or backward when needed. The catheters are removed when the procedure is completed in about 3-4 hours.
First-time success rates are nearly 85%-90%. In certain cases, partial success is achieved, in which case the patients will be asked for a re-attempt 6-8 weeks later.
Majority of the patients get discharged on the very next day after assessing their catheter sites as well as blood work. Patients undergoing CTO PCI procedure often notice improved symptoms within days to weeks. In some cases, few of the patients can see an improvement in their symptoms even before discharge. In addition, studies have demonstrated that patients undergoing CTO PCI procedure experience an improvement in their quality of life, including: