Indian Express
19 November 2010

AT a recent cardiac workshop, doctors discussed heart diseases and their causes. The workshop on Chronic Total Occlusion was organsied by Jehangir Hospital.

"Blockages in the heart pose various complex challenges to the interventional cardiologist and his team. They present themselves in various forms, shapes, sizes and locations, from a single block to multiple blocks in the same vessel. Not only that, the degree of blockage varies from patient to patient" said Dr JS Dugal, Head of Cardiology, Jehangir Hospital.

CTO means an almost complete obstruction, for more than 30 days, of a vessel supplying blood to the heart muscle. This condition accounts for 10 per cent of all angioplasty procedures. "The CTO is considered the last frontier in cardiac intervention. The success of an angioplasty procedure in such cases depends upon specialised training, experience and innovative devices designed specifically for CTOs," Dugal added.

"Crossing the complex lesion and re–entering the true lumen remains the key step in successfully performing the angioplasty," said Dr Alfredo Galassi, an Italian cardiologist who demonstrated some specialised CTO techniques at the workshop. Galassi is the associate professor of Cardiovascular Disease at University of Catania and University of Rome la Sapienza.

He went on to describe how the blockages are crossed using special plastic–coated fielder wires as against stainless steel wires.

"These soft wires are able to navi gate into the microchannels that are present in all CTOs and find their way into the true lumen of the blood vessel. This really is the key to opening CTOs".

The participants discussed the case of a 48–year–old female patient who had a long blockage in the main artery. Such complex cases are generally advised bypass surgery, however, using the special wires and four Cypher Drug Eluting Stents, the long blockage was crossed successfully. To cross the bifurcation a `mini crush' technique was used.