Hundreds of people with chronic artery blockages could benefit from a new technique to clear those old blockages.
Take Dick Talley, for instance. He likes to sail, race go-karts, and work out. Since a coronary artery bypass in 1991, the St. Leonard, Md., resident had felt just momentarily slowed by a minor stroke four years ago.
Then, early in 2014, a heart attack trimmed his sails. Deepening fatigue meant he had to rest more than garden, and skip out on sailing and racing. “I hated to admit having no energy,” says Talley, 70.
Talley’s cardiologist performed an angiogram and diagnosed chronic total occlusion (CTO), the complete blockage of a coronary artery. In addition to the original blockage, his bypass had closed. CTO occurs in 15 to 20 percent of patients with significant coronary artery disease. The cardiologist sent Talley to MedStar Heart & Vascular Institute’s interventional cardiologist Robert Gallino, MD, at MedStar Washington Hospital Center.
Dr. Gallino favored a procedure called CTO percutaneous coronary intervention (PCI). He would open Talley’s original blockage that occurred 24 years earlier.
American physicians had used a similar method on CTOs in the leg with excellent results, “and the Japanese started doing it with the heart in the early 2000s,” says Dr. Gallino. The procedure is tricky, especially this one, since Talley’s blockage was 24 years old and had grown and hardened over time. Part of the procedure involved reaching the blockage by advancing special guide wires from the right side of the heart, all the way through to the left side, where he could then open the blockage with angioplasty, a procedure to restore blood flow through the artery.
Dr. Gallino and Nelson Bernardo, MD, started performing hybrid CTO PCIs about 18 months ago. Only eight U.S. hospitals do more than 50 such procedures a year. Drs. Gallino and Bernardo do two each week.
Traditional surgery opens the chest and means a week in the hospital and six weeks’ recovery. If this procedure occurs on a Monday or Tuesday, Dr. Gallino says, the patient can be playing golf that weekend.
Talley’s procedure was clear sailing—an amazing result given the blockage was 24 years old. Such procedures used to be considered impossible.
“We’re treating blockages many people thought weren’t treatable,” Dr. Gallino says. “That’s tremendously gratifying.” As for Talley, “I went from just taking an afternoon sail around the Chesapeake Bay to feeling like I can sail around the world!” And no, that’s not a metaphor. Starting next fall, the veteran boater plans to spend three years sailing the globe. “This heart’s going to outlive me,” he says. “I’m lovin’ life.”