When a 64-year-old man developed chest pain during routine exercise in December 2023, he suspected a recurrence of the occlusion he’d had treated with balloon angioplasty 19 years earlier. His interventional cardiologists confirmed a 95% occlusion of the left circumflex coronary artery and attempted to open it with a high-pressure scoring balloon. The procedure perforated his artery, and he was sent for open-heart, single vessel bypass surgery in March 2024.
The following month, his symptoms recurred. Cardiologists discovered that the bypass graft as well as the native left circumflex artery were 100% closed, now a chronic total occlusion (CTO). “They tried another catheter procedure, but that failed,” the patient says. “They sent me home basically to be an invalid for the rest of my life.”
Six weeks after open-heart surgery, the patient self-referred to Duke for a second opinion. A Duke Heart team, consisting of interventional cardiologists and surgeons, discussed the patient and his treatment. Repeat surgery so soon was not an option, but the patient was deemed an excellent candidate for percutaneous coronary intervention (PCI) to revascularize his chronic total occlusion (CTO).
How did Duke Heart treat the patient’s CTO?
Accessing the heart through the radial and femoral arteries, interventional cardiologist Islam M. Othman, MD, used interventional guidewires, micro catheters, as well as intravascular lithotripsy to break up the plaque occluding the patient’s artery. After procedure and subsequent recovery, the patient quickly returned to full activity. “He fixed me in about 90 minutes,” the patient says. “Since my procedure, I’ve met at least three other people I’ve sent to Dr. Othman with a similar experience.”
Because few centers have the options available to treat complex heart artery disease, like CTOs, many patients are turned down for treatment. “When our team meets a patient, they’ve often been told nothing can be done or worse, nothing should be done,” says Othman. “Most of our patients have been evaluated by other interventional cardiologists before they come seek out our team. At Duke, our complex coronary intervention team figures out how to help revascularize complex coronary artery disease, including CTO, to alleviate symptoms thereby improving quality of life for our patients.”
Less than 2% of cardiac interventionalists in the U.S. can perform the full range of CTO PCI including antegrade and retrograde approaches with both wire escalation and dissection and reentry. The best outcomes for CTO PCI are seen at high-volume centers like Duke. “Our team sees greater than 90% success rates with very complex patient cases,” Othman says.
“I think Duke Heart is the perfect place for complex coronary intervention including chronic total occlusion revascularization, because our team approach — which includes heart surgeons, interventional cardiologists, and general cardiologists — combined with innovation and expertise offers patients treatment options for complex cardiovascular problems that may not be available in their local communities,” Othman continues. “At its core, it’s about helping more people feel better and giving them more options for improved quality of life.”
