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New Hope for Unhealthy Hearts

Innovative procedure helps patients with completely blocked arteries

Story by Jo Ostgarden

Dieter Lubbe, MD, is one of the Spokane, WA cardiologist physicians at Providence using a new procedure to clear completely-blocked arteries.
Dieter Lubbe, MD, is one of the physicians at Providence using a new procedure to clear completely blocked arteries.

For more than 10 years, Spokane resident Rick Hoadley lived with the chest pain and fatigue of heart disease. His stress levels rose when the economy tanked, and eventually, the combination nearly killed him.

Healthy coronary arteries are muscular, highly elastic tubes that supply blood to heart tissue. But when fatty material builds up along artery walls, the vessels become stiff and narrow. Angioplasty and coronary stenting are often straightforward treatment options.

When the arteries become 100 percent blocked for more than a few months, like Hoadley’s, the condition is called chronic total occlusion (CTO)—and that requires advanced treatment. In the past, open-heart surgery would have been necessary, but today, interventional cardiologists at Providence Spokane Heart Institute use a minimally invasive technique to help patients return to health more quickly.

Skilled Cardiologists

Hoadley tried to manage his condition with medications because he couldn’t afford surgery. Eventually he used a defibrillator, a device that detects life-threatening rhythm disturbances and delivers a shock to the heart to prevent sudden death. One night in late June, Hoadley says, he “died” twice, and each time the defibrillator brought him back.

Thanks to Project Access—a local program that connects physicians and hospitals to patients who can’t afford care on their own, Hoadley received the assistance he needed to treat his medical condition.

At Sacred Heart Medical Center’s Catheterization Lab, he underwent a procedure performed by Philip Huber, MD, and Dieter Lubbe, MD, who have more than 30 years of combined angioplasty experience and 10 years of CTO experience.

A Precision Technique

The new procedure is called CTO revascularization, which restores blood flow through the completely blocked artery. At first glance, it looks like standard angioplasty, but improved tools and techniques set it apart. The limited success of angioplasty for CTO, says Dr. Lubbe, is primarily because of the difficulty of maneuvering through the rock-hard plaque blockage with conventional guide wires and devices.

Trying to penetrate a CTO with standard angioplasty, he says, is akin to “trying to blast through rock.”

The new guide wire system allows for precise threading around the blockage in the inner and middle layers of the artery wall (much more precise than standard angioplasty). Once a balloon catheter is advanced far enough beyond the blockage, blood flow is restored and a tiny mesh coil known as a stent is placed to keep the artery from narrowing again.

While CTO revascularization takes longer to perform than angioplasty (2.5 hours compared with about an hour for angioplasty), it minimizes fluoroscopy, the use of X-ray to obtain real-time moving images of the artery. Lower radiation exposure is better for patients.

In experienced hands, CTO revascularization has a success rate of 80 to 90 percent with a low complication rate. Successful procedures increase heart function, reduce angina (chest pain) and improve physical capacity. Both cardiologists say it’s gratifying to see patients—who were forced to dial down their activity just to survive—get back to doing the things they enjoy.

Rehab After Procedure

Heart patients are encouraged to get up and move as soon as possible to prevent clots from forming in leg arteries. Hoadley says that even though he was sore, he was walking the hospital floors within 24 hours after the procedure. He told Dr. Lubbe the next day: “It’s the first morning I haven’t felt chest pain in 10 years.”

Hoadley enthusiastically credits the two Providence Spokane cardiologists with saving his life. “I’m getting better, stronger, every day. I’m just astonished at how well this went and how good I feel.”

Part of the success of the new procedure, Dr. Huber says, comes from the team’s meticulous assessments of patients, the experience of the team and advanced technology.

CTO revascularization is bound to become even faster and more successful with time, offering positive outcomes like Hoadley’s to many more patients in the days ahead.