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Your Healthy Family: How NCH treats some coronary artery blockages

Posted at 7:20 AM, Feb 13, 2023
and last updated 2023-02-13 07:20:12-05

NAPLES, Fla. — February is American Heart Month. Fox 4 is taking a deeper look at a heart condition that impacts 40 percent of people over the age of 65: chronic total occlusions, or CTOs, and how doctors with NCH Healthcare System treat them.

"CTO stands for chronic total occlusions, which are coronary arteries that are blocked and have been blocked for quite some time," NCH Interventional Cardiologist Dr. Adam Frank said.

At least 3 months, to be exact. Dr. Frank said a CTO happens when a coronary artery, which supplies blood to your heart, becomes almost completely blocked with plaque.

"The plaque or the obstruction becomes calcified. It's very challenging to push through. And the longer it's there, the much harder it is to get through," Dr. Frank said.

He said that plaque can be caused by high cholesterol, diabetes, or being overweight, inactive, and eating a poor diet. And it can lead to heart disease.

"Most people that have heart disease, they typically think they need to have chest pain, tightness, pressure," Dr. Frank said. "But CTOs, because by definition they've been there for a while, a lot of those classic symptoms of discomfort aren't always the predominant symptom. So shortness of breath is a very, very commonly described symptom. Fatigue, exercise intolerance."

Dr. Frank said many times, people can have this kind of blockage in their coronary artery for years without even knowing.

"Because the symptoms could potentially be so sort of generic -- fatigue, shortness of breath -- people may attribute that to getting older or slowing down. They don't realize it until they are evaluated, they may come to the cath lab, have an angiogram, and then they're diagnosed with having a chronic occlusion," he said.

Dr. Frank said doctors find a CTO about a third of the time they do a heart exam using x-ray imaging or through a catheter.

"And it's one of the leading causes for people to be referred for surgery, coronary bypass surgery," he said.

But that's not the only treatment option available. Dr. Frank said NCH Healthcare System was the first in Naples to offer another treatment option called Percutaneous Coronary Intervention. It's a less invasive surgery done through a small incision in the wrist or groin.

During a coronary bypass surgery to clear a CTO, doctors essentially create a new pathway for blood to flow around a blocked artery.

"Unfortunately, not in all cases do people get treated with surgery. Sometimes they are deemed to be at prohibitive risk for surgery," Dr. Frank said. "If they don't meet criteria for surgery, they may be left really just to handle their symptoms medically. And it affects your quality of life."

He said with a lot of effort, they learned another technique to treat CTOs.

"It allows us to open up these arteries that have been chronically closed and provide better blood flow to the heart muscle, alleviate symptoms, and make people feel better overall," he said.

Through a catheter in the wrist or groin, Dr. Frank said they get into the coronary artery where that blockage is.

"You have to dig a little bit. You may have to break open that plaque, that cap a little bit. Or the more sophisticated technique, where you actually dissect around the blockage, and then you create a whole new channel," he said. "There are specialized balloons, there's a laser, there are special techniques which allow us to actually intentionally dissect and go around the blockage. We put a wire through the vessel, we expand a balloon to kind of push that plaque aside to restore flow."

And Dr. Frank calls it a game changer.

"I've been here close to 15 years. I've seen many, many patients with chronic occlusions that, unfortunately, we either referred for surgery, or couldn't get surgery, and we really haven't had the level of expertise that we now have to offer them a treatment," he said.

He said they treated their first patient with this procedure in June.

"An eighty-year-old gentleman, retired physician, who loved to play tennis, and his symptoms were just on the tennis court. He found himself becoming more and more fatigued. Despite medical therapy, he really couldn't get out of his own way, so to speak. We spent about two hours getting the vessel open. It came out great. And literally the next week, he's back on the tennis court. And he said his symptoms are gone," Dr. Frank said.

And since then, doctors at NCH doing this procedure have only gotten even more efficient.

He says patients who have this procedure usually go home the next day with just a bandaid on the spot doctors went in for the procedure.