Since Interventional cardiology has taken wings as a procedure, CTOs have always been a difficult challenge for Interventional cardiologists. CTOs are heart blocks, which completely block, typically above 99% of the artery space and have been existing for more than three months or years. This complete blockage of the artery results in significant decrease of blood supply, gradual reduction in the pumping ability of the heart and consequent death. According to studies, prevalence of CTOs in patients with Coronary artery disease is as high as 15-20%.
Previously it was believed that these can be left alone as there would be enough reserve from the other arteries to compensate for this reduction. But recent data indicates that these lesions are risky if left alone. In fact these are the only group of patients where a definite improvement in survival was documented after angioplasty-stenting procedure.
Conservatively treating such patients through Medical option may not be sufficient to relieve symptoms or to improve long-term outcomes. Conventionally Coronary artery bypass surgery (CABG) has been the only treatment option for CTOs. Several factors such as various complications associated with a major surgery, the prolonged recouping time, presence of kidney malfunction, post by-pass surgery re appearance of blocks, elderly age of patient and reluctance by the patient to undergo a major by-pass surgery preclude the doctor to offer by-pass surgery for all. That is the reason over the last 2 years there is enormous interest amongst various Cardiologists to learn how to deal with this complex problem.
With this new minimally invasive technique called Chronic Total Occlusion Percutaneous Coronary Intervention, an angioplasty is performed to treat CTOs, thereby avoiding surgery. CTO PCI can reduce the need for CABG in 50 to 75% of the CTO patients.
According to Dr. Raghu, CTO PCI is the most challenging procedure and requires greater skill and experience on the part of cardiologists, but it presents several potential benefits for the patients including improvement in symptoms, improvement in left ventricular (LV) function, and improvement in survival rates. However not all patients with CTO may be eligible for CTO PCI and has to be assessed and decided by the Cardiologist on a case to case basis, adds Dr. Raghu.
Prime Hospital is organizing the Chronic Total Occlusion Summit on the 8 and 9 of March 2013 at Hotel WestIn. The faculty comprised of two renowned Japanese doctors, Prof Yasushi Asakura from Toyohashi heart Centre and Dr Yuji Hamazaki from Showa University Hospital. In addition there are live transmissions from Europe – Dr Giorgios Sianos from Greece; Dr Yves Louvard, France; Dr James Spratt, United Kingdom and Dr Ashish Pershad, USA and Prime Hospital Cardiologists Dr C Raghu, Dr MSS Mukharjee, Dr Movva Srinivas. Over the two days a total of fifteen cases will be performed and discussed at the meeting by the delegates. The delegates about 100 in number are coming from various parts of India. Delegates who are attending are highly skilled doctors keen on extending the angioplasty option to the difficult subset of chronic total occlusion patients.
This effort by Prime Hospitals is one of the initiatives to share knowledge amongst Cardiologists of India, says Dr B Naga Raju, Managing Director, Prime Hospitals.
A book authored by Dr. C Raghu on 100 Questions and answers about Chronic Total Occlusion was released on the occasion.
