Ground-breaking new “CTO PCI” cardiology procedure changing lives of Tulane Health System patients

Billie Findlay thought she was out of options when she was referred to Tulane Health System interventional cardiologist Dr. Nidal Abi Rafeh. The 85-year old resident of Tyler, Texas, had a history of heart disease, and she was told that the traditional treatment of open heart surgery was too risky because of her age and medical condition.

“I kept experiencing shortness of breath and swelling in my ankles,” Findlay said. “With no other options, I actually began preparing for the end of life.”

That all changed when Dr. Abi Rafeh scheduled Findlay for a “CTO PCI” at Tulane Medical Center and spent several hours reopening Findlay’s blocked arteries using the breakthrough procedure. Later that day, Findlay woke up to wonderful news – her arteries had successfully been propped open, allowing normal blood flow from the arteries to her heart.

Dr. Abi Rafeh, along with fellow Tulane interventional cardiologist Dr. Owen Mogabgab, are pioneering this new treatment technique, and they will soon will lead a specialized training seminar designed to offer physicians across the South a new alternative for treating coronary chronic total occlusion, or CTO. “Foundations of CTO: Master the Complex,” a regional training and education program sponsored by Boston Scientific Corporation, will be held Sept. 30 at the Tulane Medical Center downtown campus.

CTO PCI, or chronic total occlusion percutaneous coronary intervention, is a breakthrough procedure to treat patients who have a totally blocked coronary artery vessel. At present, only 2 percent of interventional cardiologists in the United States are qualified to perform the full range of these procedures, and Tulane Health System is one of the few centers in the country to offer it.

CTO in particular has presented challenges for even the most experienced interventional cardiologists. In many cases, standard angioplasty and stenting techniques do not work in cardiac patients with 100 percent blockage of the coronary artery.

Historically, physicians often recommended coronary artery bypass grafting (CABG), or open-heart surgery, as the only option for treating these blockages. Some patients, however, are not candidates for CABG surgery due to age or high surgical risk.

Tulane’s innovative CTO PCI procedure allows physicians to approach a coronary blockage from multiple sides, using a combination of advanced imaging, tiny coronary guide wires and refined surgical techniques. Interventional cardiologists gently steer special guide wires and catheters across the blockages, instead of tunneling through them. New technology makes fine movement of the guide wire tip much easier to control than in the past.

“It is so good to be able to take a deep breath again,” Findlay said. “What a difference Dr. Abi Rafeh has made in my life.”

Dr. Abi Rafeh said there is now another option to treat people with complex coronary artery disease. “In the past, treatments were limited to medication, conventional angioplasty and stenting, or bypass surgery. Fortunately, the field of interventional cardiology is rapidly evolving, and this minimally invasive, game-changing procedure can successfully reverse symptoms and vastly improve cardiac function among patients who thought they had run out of options.”

For more information about the procedure, or to read more about Findley’s story, please visit the chronic total occlusion treatment page.