WellSpan Offers Complex Care for Heart Blockages

By Barry Sparks

Patients with complete blockages in their hearts can undergo a complex yet minimally invasive procedure by experts at WellSpan York Hospital, allowing them to avoid surgery and quickly return to their normal life.

Called complex chronic total occlusion percutaneous coronary intervention, or CTO/PCI, the procedure is an alternative for patients who have had a complete blockage of one or more coronary arteries for at least three months.

WellSpan York Hospital performs about 250 of these procedures a year, making it one of the top hospitals in the country to offer the technically challenging treatment. Its expertise results in referrals from physicians across the East Coast, who send their patients to York to undergo the procedure.

“Cardiologists must undergo intense training to be able to perform CTO/ PCI efficiently,” says Dr. Rhian Davies, who completed a year-long fellowship, during which she performed more than 400 of these complex procedures. “The more procedures you perform, the better prepared and equipped you are.”

CTO/PCI is a minimally invasive procedure. An interventional cardiologist inserts a small tube called a sheath into blood vessels in the wrist or groin.

Next, a catheter (a smaller tube) is placed within the sheath and directed through the heart and to the affected coronary artery. The interventional cardiologist then inserts a thin guide wire through the catheter and across the narrowed or blocked section of the artery.

This is followed by insertion of a second smaller catheter, equipped with a balloon that is inflated within the narrowed or blocked section of the artery. The balloon opens the artery and restores blood flow to the heart. The doctor may place a stent, a small mesh tube, into the newly opened section of the blood vessel to hold the artery open. “Most patients feel substantially better and their symptoms are improved after the procedure,” says Davies. “This improves their quality of life, which is the goal.” In most cases, patients spend just one night in the hospital following the procedure.

The Signs and Diagnosis of CTO

Patients who are at risk of chronic total occlusion (CTO) are those who smoke or have high cholesterol, diabetes, high blood pressure, a history of heart attack, or known coronary disease and obesity. Their symptoms can include chest discomfort, shortness of breath, dizziness,

Dr. Rhian Davies, director of fatigue, nausea, pain in the upper body or Complex Coronary Interventional arm, and rapid or irregular heartbeat.

Cardiology at WellSpan. Diagnosis of CTO involves a patient’s medical history, a physical exam, and a coronary angiogram procedure, which takes images of the arteries. Other tests for CTO may include electrocardiograms, echocardiograms, stress tests, nuclear medicine PET scans, and cardiac MRIs. Besides CTO/PCI, other treatment options for CTO include medications, which can have side effects, and open-heart surgery, which may not be an option for all patients. Davies says CTO/PCI treatment will continue to evolve. “Technology and technique are becoming more refined,” she says. “We’re seeing new developments in catheters and devices to help facilitate opening of these blockages. Interventional cardiologists are becoming more comfortable with the procedure, and complication rates are decreasing. The procedure is becoming safer.”