Interventional Treatment of Chronic Total Occlusion

Here, Farouc Jaffer, MD, PhD, director of the Coronary Intervention Unit and the Chronic Total Occlusion Percutaneous Coronary Intervention (CTO PCI) program, discusses his research investigation on treatment for patients with chronic total occlusion (CTO). Often times patients with these total blockages in their coronary arteries are not aware of interventional options and they may be referred to bypass surgery or not offered treatment at all. Dr. Jaffer believes that the CTO PCI Program is important for improving the safety and efficacy of treatment. This program ensures that proceduralists, non-invasive cardiologists and patients are all involved in the process of deciding whether or not to undergo CTO PCI.

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Transcript

One important area of research for our program is the investigation of treatment of patients with chronic total occlusion or 100% blockages in their coronary arteries, and that is because this is one of the most difficult subsets to treat with angioplasty or stenting. It turns out, many patients, because they are not aware of interventional options, will often be referred to bypass surgery and in some cases, even worse, these patients will not be offered treatment at all and often be limited in their symptoms with both angina and shortness of breath. Because of this unmet need in treating these patients, we have been very interested in developing and advancing a clinical program as well as novel imaging approaches to be able to help make these procedures safer and more effective.

On the clinical side, in the chronic total occlusion sphere, we are bringing the first in U.S. technology to image the actual coronary total occlusion using CT, infusing that on top of the actual x-ray angiogram during the live case. And, what that allows us to do is to see the part that x-ray angiography or cardiac catheterization fills the artery with contrast, but the gap, the 100% total occlusion is not seen. So the course can be ambiguous, can be calcified, we can't see that, and that affects our procedure. With CT, we get this procedure ahead of time. We can see the gap because CT can see the wall. We can take that information, fuse it on top of the x-ray, and know exactly where to go and what type of material we are crossing.

We believe that this novel technology, which is starting to disseminate, will really make procedures safer, more efficient and more durable. A really important part of this is making sure we understand doctors' perceptions and patients' perceptions of this procedure, CTO PCI. Elective procedures such as CTO PCI are usually approached differently than urgent or emergency procedures. We meet each patient in the office to discuss risks and benefits. And what is very interesting is that a proceduralist who tends to work with his hands is often very aware of their successes and their ability to guide a patient successfully through that procedure. But sometimes, and this is natural for proceduralists, is they may, in their own minds, diminish challenges or complications associated with that procedure.

Non-invasive cardiologist has a broader approach sometimes in understanding the sphere of medical therapy and interventional therapy, and we believe in our CTO program that they are invaluable. When we make a decision to take patients to CTO PCI, it is done collaboratively with a non-invasive cardiologist or primary care cardiologist because we want to make sure that the patient is treated really holistically. We certainly have our differences in terms of what we believe that procedure can offer in terms of specific details, but that balance is really great for patients. It gives them a really balanced approach to think about whether or not they should proceed with such a procedure.

Learn more about the CTO PCI Program

Refer a patient to the Mass General Heart Center