Minimally invasive complex coronary artery disease treatment

Heart disease can cause fatigue, shortness of breath and tightness in the chest which can affect your quality of life. Fortunately, there are new treatment advances that can help. At the HCA Midwest Health Heart and Vascular Institute, our interventional cardiologists offer a non-surgical, minimally invasive approach to clear clogged coronary arteries – even arteries that are completely blocked. These percutaneous coronary intervention (PCI) therapies may even be an option if you:

  • Were previously told that your coronary artery disease is too complex
  • Are on medicine and still have symptoms
  • Were previously told heart bypass (open heart surgery) was not an option

Benefits of the HCA Midwest Health Heart and Vascular Institute

  • Leading-edge treatments – We offer the latest life-saving therapies including the hybrid approach for chronic total occlusion percutaneous coronary intervention (CTO PCI) which offers hope for many patients who may not have had a viable treatment option before
  • Experienced in complex coronary artery disease treatment – We perform over 100 CTO PCI procedures a year and train other physicians around the country on the hybrid approach. Patients also travel from hospitals around the region to receive these life-saving procedures
  • Pioneers in treating complex cases – Our cardiologists performed the first bi Impella protected PCI procedure in the Kansas City region
  • Prominent leaders in chronic total occlusion research – Our cardiologists are involved in clinical studies, published numerous papers and are invited speakers on CTO PCI procedures
  • A team approach to care – Our dedicated multi-specialty CTO PCI team consists of highly-skilled surgeons, interventional cardiologists, cardiologists, nurses and technicians work together to develop the best treatment plan for each and every CTO procedure patient
  • Advanced technology – We offer robotic-assisted percutaneous coronary intervention for increased precision at Overland Park Regional Medical Center
  • Four convenient hospital locations in Kansas City – Centerpoint Medical Center, Menorah Medical Center, Overland Park Regional Medical Center and Research Medical Center

To refer a patient for a consultation at the CTO clinic, call the number below. To find a physician, please call (816) 823-0668.

(816) 399-7620

Meet Our PCI Physicians

Learn more about our heart doctors by watching the video playlist below:

Hybrid CTO PCI Heart Specialists

Find an Interventional Cardiologist in Kansas City

Coronary Artery Disease

Coronary artery disease (CAD) is a leading cause of death and disability. CAD occurs when atherosclerosis (fatty plaque buildup that hardens overtime) effects your coronary arteries. This can obstruct blood flow to your heart. CAD develops over years so you may not have symptoms until there is a significant blockage.

Coronary artery disease symptoms include:

  • Chest pain (angina)
  • Pain that can spread to the arms or jaw
  • Shortness of breath
  • Fatigue
  • Heart attack

What is CTO?

CTO stands for chronic total occlusion. Chronic total occlusions are arteries that are completely blocked for three months or more. Because these arteries are 100% blocked, they can be very challenging to open. You will need an experienced cardiologist who specializes in hybrid CTO revascularization.

What is Percutaneous Coronary Intervention?

PCIs are heart procedures that are performed on the coronary arteries through a needle puncture in the skin. They are minimally invasive and are used to open clogged coronary arteries and restore blood flow to the heart.

When performing a PCI, your interventional cardiologist will make a small incision in your wrist or groin and guide catheters up to the heart. An angiogram (x-ray technology and contract dye) is used for visualization.

Prior to relatively new PCI procedures, it was very difficult to clear blockages in people with complex coronary artery disease.

Complex CAD can include patients with:

  • Advanced age
  • Severely or completely blocked arteries
  • Frail physical condition

There are several PCI procedures. Talk to your cardiologist about which procedure may be right for you.

  • Balloon Angioplasty (Revascularization by PCI)
  • Angioplasty with Cardiac Stent
  • Chronic Total Occlusion (CTO PCI)
  • Robotic-assisted angioplasty
  • Protected PCI

Coronary Angioplasty

Percutaneous transluminal coronary angioplasty (PTCA), or percutaneous balloon angioplasty, is a minimally invasive procedure used to open narrowed or blocked arteries. Once the catheter reaches the area causing the issue, a tiny balloon is inflated to open the artery. The balloon is then deflated and removed.

Angioplasty with Cardiac Stent

A coronary heart stent procedure is a balloon angioplasty with the addition of a stent. A stent is an expandable tube, usually made of a mesh metal wire, which is used to hold the artery open. There are many different types of stents including ones that release medication to help prevent excess tissue from re-blocking the artery.

Once the narrowed artery is opened with the balloon, a stent is placed at the site of the blockage. Stents are usually recommended for people with moderate to severe coronary atherosclerosis.

Procedure Time: 1-2 hours

Hospital Stay: Usually requires an overnight stay for monitoring

Follow-up: You will have an appointment with your cardiologist within 2 weeks of the procedure

Recovery: Most patients are able to walk the day after the procedure and can return to normal activity within a week. Discuss specific activity restrictions with your heart care team.

Results: Heart stent procedures can help to relieve symptoms and restore blood flow in about 90 percent of patients. However, the effectiveness of treatment and its’ benefit over time can vary based on many individual factors. There is a risk of recurrent symptoms due to further narrowing or plaque buildup in another place. Talk to your doctor about the results you can expect.

Robotic-Assisted Angioplasty

The HCA Heart and Vascular Institute offers robotic-assisted angioplasty at Overland Park Regional Medical Center. The advanced technology allows your interventional cardiologist to control the angioplasty tools with increased precision. Your doctor is able to measure your anatomy to help choose the best stent for you and move the stent a millimeter at a time to position it exactly where it needs to be. The robotic system also allows for better visualization during the procedure. These benefits may lead to a shorter procedure and less exposure to radiation.

Chronic Total Occlusion (CTO PCI)

The longer an artery is blocked, the more difficult it can be to open. Previously, coronary artery bypass grafting (CABG), or open heart surgery, was the only method of treating CTOs. Fortunately, new minimally invasive methods have been developed called chronic total occlusion percutaneous coronary intervention. These procedures have been able to improve success rates and safety for patients with complex coronary artery disease.

The interventional cardiologists at the HCA Midwest Heart and Vascular Institute perform a full range of CTO PCI procedures. During a CTO PCI, your interventional cardiologist will use advanced imaging and next generation coronary tools to go around or through the blockage. New surgical techniques allow cardiologists to approach the obstruction from multiple sides by:

  • Steering a guidewire through the tiny new blood vessels that formed around the blockage
  • Carefully piercing the skin of the artery wall and steering the guidewire between the layers of tissue (artery walls have 3 layers). The interventional cardiologist will then reenter the blood vessel and place stents on both sides of the blockage

Procedure Time: 1-3 hours

Hospital Stay: Most people can go home the next day.

Follow-up Care:  You will have a follow-up appointment with your cardiologist within 2 weeks of the procedure.

Recovery: Many patients are able to walk the several hours after the procedure and can return to normal activity within a week. Discuss more detailed activity limitations with your cardiology care team.

Results: CTO PCI is able to effectively clear blockages, reverse symptoms and improve heart function. Talk to your doctor about the individual results you can expect.

Protected Percutaneous Coronary Intervention

A protected PCI is when you undergo a PCI procedure with the added support of a heart pump such as the Impella. A heart pump allows your heart to rest by assisting with the pumping function.

During a percutaneous coronary intervention there may be planned interruptions in blood flow. This may cause issues in some people that are at high-risk and can lead to an incomplete procedure and a poorer outcome. A heart pump can support the heart by facilitating blood flow and allow your cardiologist to complete the procedure. This can result in a shorter hospital stay and a faster recovery.

If your heart needs support even after the procedure, your cardiologist may leave the Impella in place until you are in stable condition.

You may be a candidate for a protected PCI if:

  • You have severe coronary artery disease
  • An angioplasty or stent procedure is risky
  • You are not a candidate for surgery
  • You have additional health risks such as diabetes, kidney disease or obesity

What is a Bi Impella?

A bi Impella is a protected PCI procedure where two heart pump devices are used to support the heart (one in the left ventricle and one in the right ventricle). One pump will support the right side and one will support the left. This allows patients to have adequate support while we safely get them through a higher-risk procedure.

Procedure Time: 2-5 hours

Hospital Stay: Hospital stay length will vary depending on when you are stable enough to allow the heart pump to be removed.

Follow-up Care: You will have a follow-up appointment with your cardiologist within 2 weeks of the procedure.

Recovery: Many patients who undergo a protected PCI are able to return to their normal activities within one week after leaving the hospital. Talk to your cardiology team about your specific recovery expectations.

Results: Many people see an improvement in CAD symptoms after the procedure. Talk to your doctor about the individual results you can expect.