Patients with complex coronary artery disease (CAD) have more options than ever before to manage debilitating symptoms and improve overall outcomes. “It’s not just one tool or device,” says UVA Heart and Vascular Center interventional cardiologist Michael Ragosta, MD. “It is a collection of techniques, skills and strategies, in addition to the advances in devices — the guidewires and catheters — that allow us to successfully treat these patients through percutaneous methods.”
When conventional treatments like medication prove ineffective or patients are too high risk to undergo traditional surgery, Ragosta encourages referring providers to look to academic medical centers like UVA for an alternative. “We would love the opportunity to see these patients, to render an opinion,” he says. “It’s very likely we would be able to offer them a solution to improve their quality of life.”
As you know, patients with complex coronary disease often can be medically stable, sometimes for many years. But eventually, symptoms like shortness of breath, fatigue and angina become debilitating. So the decision to treat is driven by the patient and is based on the severity of symptoms.
Whom to Refer
Patients who may be considered for percutaneous coronary intervention (PCI) at UVA include those with:
- Chronic total occlusion (CTO)
- Extensive or significant calcifications
- Calcifications in tortuous arteries
- Severe multi-vessel disease
- Reduced heart function
- Bifurcation blockages
- A previous condition that requires a repeat heart procedure
Why Refer to UVA
While many consider these patients too high risk or too complicated for percutaneous coronary intervention, UVA has made a concerted effort to learn the techniques and acquire the tools needed to care for them effectively. And it’s working. “Our complication rate for PCI is very low despite the fact that the patients we treat are very high risk,” says Ragosta. “This is a testament to our multidisciplinary approach to care. We receive input from surgery, perfusion, nursing, respiratory therapy and others. The entire team and the post-procedure care they provide are a critical piece; it’s not just about the physician.”
New Hybrid Approach
To further their efforts to treat complex CAD, specifically multi-vessel disease, UVA is investigating a new hybrid approach to treatment that combines the best angioplasty techniques with proven surgical approaches. “We are now enrolling patients for this NIH-sponsored study that allows us to avoid the traditional bypass surgery with sternotomy in favor of a less-invasive approach,” says Ragosta.
For this hybrid procedure, surgeons utilize a minimally invasive approach to graft the left anterior descending artery (LAD) using the left internal mammary artery (LIMA). This is followed by stenting of the non-LAD arteries. Find out if your patient may be eligible for the Hybrid Coronary Revascularization Trial.
To refer a patient to UVA Heart Center, call UVA Physician Direct at 800.552.3723.