Duke Health Referring Physicians

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Microdevice Tactics Clear Arteries, Help Patients Avoid Surgery

Providing a team-based treatment approach to achieve complete revascularization for patients with chronic total occlusion (CTO) is the guiding principle for Islam M. Othman, MD, an interventional cardiologist and director of Duke’s Chronic Total Occlusion and Complex Coronary Intervention Program, which offers clinics in Wake Forest, South Durham, and Raleigh.

A specialist in complex percutaneous coronary intervention (PCI), Othman has extensive experience with complex coronary revascularization procedures using microcatheters to navigate chronically occluded coronary arteries. Specialized tools such as rotablation atherectomy catheters are used to break up calcified cholesterol and plaque without requiring surgical interventions. These tools and training give Othman and his team the ability to treat dense arterial blockages that cannot be addressed with traditional catheter technology.

The complex coronary revascularization team’s use of advanced procedures is restorative for many patients presenting with CTO, including patients who are not surgical candidates because of comorbidities.

“Where clinically indicated and appropriate, we want to ensure that each patient is returned to a state of complete revascularization with improved blood flow to the entire heart muscle,” Othman says. “That requires a thorough assessment of cardiovascular health with close involvement of the entire team including the patient, their family, primary care provider, and cardiologist as well as surgeon.”

Patients with CTO commonly seek care initially after experiencing angina, Othman says. Symptoms such as chest discomfort, shortness of breath, increased effort required for breathing, an “air hunger” sensation, or fatigue as well as other conditions may indicate underlying coronary artery disease. In the Canadian Multicenter CTO Registry, 18% of patients undergoing coronary angiography had at least a single CTO.

Conservative medical therapy alone has limited effectiveness in treating chronically occluded coronary arteries in symptomatic patients, Othman notes. “These patients are often left in a chronically debilitated state of incomplete revascularization with ongoing symptoms of cardiac angina,” he says. “It can be a frustrating cyclical experience for many of these patients.”

Othman’s microcatheter-based procedure reflects a transition to a new paradigm in CTO treatment that, for select patients, avoids coronary artery bypass graft surgery. This strategy ensures patients receive an assessment of their long-term outlook and consider all therapies before any CTO procedure is selected.

Advanced revascularization of CTO, Othman acknowledges, is only part of the team’s approach. “Stents alone don’t treat cardiovascular disease.”

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To refer a patient, call Duke Heart Center at 919-681-5816 or log in to Duke MedLink.