January 19, 2018 by John Fernandez and Tanya Racoobian
Complex Artery Repair Gave Him His Life Back
When a coronary artery, which supplies oxygen-rich blood to the heart muscle, is completely or nearly completely blocked, it is known as chronic total occlusion, or CTO.
Charles Jones, 72, an accountant, knows a thing or two about heart problems, and especially CTOs. He made it through a 2008 triple bypass, and for the most part, had lived a fairly active and healthy life since. That is, until he started to develop chest pains late last year and could barely walk a few steps without assistance.
“The first time they hit, I was walking through the airport and I almost passed out. Unbearable pain,” he recalls.
While at South Miami Hospital, doctors told him he had significant blockage in his arteries again, and that a cardiac catheterization would be required to pinpoint the areas that would need stents. When your heart suffers from ischemia, you will typically experience pain or discomfort in your chest. Angina is the medical term for this sensation, which is the most common symptom of coronary artery disease (CAD).
In the case of Mr. Jones, there were comorbidities (the simultaneous presence of two chronic diseases) that needed specialized care before he would undergo the stent procedures to clear his CTO, or blocked artery. His secondary chronic condition: kidney disease. That was January, when he was told he needed to have an intervention, or reopen one of the arteries of his 2008 bypass operation.
He was treated with an increase in his medical therapy, but he still had recurrent angina. Four months passed before Ramon Lloret, M.D., an interventional cardiologist at Miami Cardiac & Vascular Institute at Baptist Hospital, part of Baptist Health South Florida, proceded with a cardiac catheterization and angioplasty procedure. During a “cardiac cath,” a thin, hollow tube called a catheter is inserted into a large blood vessel that leads to your heart. The catheter is commonly inserted in an artery or vein in your groin or arm.
Mr. Jones’ kidney problem made it higher risk for Dr. Lloret to perform a key part of the cardiac cath, the injection of a chemical dye. A contrast dye is visible in X-rays after it is injected through the catheter. The X-ray images then show the dye as it flows through the heart arteries, giving doctors the best indication of where arteries are blocked. However, contrast dyes can decrease kidney blood flow and lead to renal failure, especially in the patients with chronic kidney disease and diabetes.
“We have to learn to do what’s best for patients,” says Dr. Lloret. “It’s common for patients with heart disease to have kidney issues. It’s something we deal with. When the time came, we took precautions, such as establishing intravenous fluid replacement for 12 hours prior to the procedure and limiting contrast dye by using intracoronary ultrasound, which doesn’t require dye. It went very well.”
‘I Wanted to Have a Good Quality of Life’
In a stent procedure to open up blocked arteries, a catheter (thin flexible tube) is inserted in the femoral (groin) or radial artery through blood vessels until it reaches the site of blockage.
“Dr. Lloret said it was fairly risky,” recalls Mr. Jones. “I told him I wanted to have a good quality of life, instead of dealing with a life where I couldn’t do anything. Even sitting down gave me chest pains.”
While a catheter is commonly inserted through one side of the groin to reach an artery or vein, Dr. Lloret had to go through both sides of the groin in Mr. Jones’ case to open the chronic total occlusion. Dr. Lloret was able to pass wires and balloons to open up the left main artery going into the circumflex artery. This had more that a 20mm length of occlusion. By passing wires, both antegrade and retrograde, he was able to cross the long 100 percent blockage in Mr. Jones native coronary artery — instead of relying on a vein graft which may only stay open for a short time.
“I give Dr. Lloret and his team a lot of credit,” says Mr. Jones. “They took their time and figured out what had to be done.”
Dr. Lloret says that Mr. Jones faced more complications than other stent candidates, but treating CTOs is a specialized field that requires understanding all possible challenges with intense study of catheterization films and advanced catheter skills.
“We handle these higher-risk cases with excellent outcomes, using the proper tools and expertise,” says Dr. Lloret. “It takes special team work to handle CTOs from the doctors down to the nurses and technicians. Charles is doing great now and he hasn’t had angina again. We decreased some of his medication and he’s very active. He swims on a regular basis and he feels great.”
Mr. Jones said doctors and nurses got him walking after his stent procedure. The whole procedure lasted from 9 a.m. to 4:30 p.m.
“It took me a while to recover, but I’m feeling good,” says Mr. Jones of his life after his April angioplasty by Dr. Lloret. “The older you get, the longer the recovery time, but I’m doing really fine right now. I’m not having any kind of pain. That’s the main thing. I’m at a stage in my life, where I want to travel and do things. Now I can.”