COMPLEX CORONARY PATHOLOGY UNIT: CHRONIC OCCLUSIONS
Unit Manager: Dr. Felipe Hernandez
The Complex Coronary Pathology Unit: Chronic Occlusions is a specialized unit at UICAR that studies patients with a chronic obstruction (at least 3 months old) of one of the main coronary arteries. This means that the blood supply through that artery is negligible or nonexistent, and can cause symptoms or some degree of decreased heart function.
This anatomical context is often discovered when patients undergo tests that analyze the coronary arteries, either a CT scan of the coronary arteries or invasive coronary angiography.
This unit integrates clinical cardiologists, cardiologists dedicated to advanced cardiac imaging, and interventional cardiologists with experience in the treatment of chronic coronary occlusions.
- What is the chronic occlusion unit?
- Studies and treatments
- Treatments to highlight
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The Complex Coronary Pathology Unit: Chronic Occlusions is a specialized unit at UICAR that studies patients with a chronic obstruction (at least 3 months old) of one of the main coronary arteries. This means that the blood supply through that artery is negligible or nonexistent, and can cause symptoms or some degree of decreased heart function.
This anatomical context is often discovered when patients undergo tests that analyze the coronary arteries, either a CT scan of the coronary arteries or invasive coronary angiography.
This unit integrates clinical cardiologists, cardiologists dedicated to advanced cardiac imaging, and interventional cardiologists with experience in the treatment of chronic coronary occlusions.
Many cardiologists consider chronic coronary occlusions a common finding. Medication treatment is often insufficient to control these patients' symptoms or generates collateral side effects. In many cases, revascularization surgery is not a reasonable option due to the patient's clinical profile (advanced age, other pathologies), their coronary anatomy, or their preference for less aggressive treatment. In these scenarios, percutaneous coronary intervention may be the only option to improve these patients' symptoms and/or prognosis.
There are multiple studies comparing drug treatment versus catheter-based revascularization and stenting. Not all patients are candidates for invasive treatment, as certain criteria are required: the presence of angina, left ventricular dysfunction, or ischemia demonstrated by testing. In these cases, which should be carefully selected, the prognostic benefit of opening the obstructed artery is supported by the clinical practice guidelines of the major cardiology societies.
Traditionally, interventions for chronic occlusions are performed much less frequently than for severe but non-occlusive coronary lesions. There are many reasons to adopt a conservative approach, but the main reason why catheter-based interventions for chronic occlusions are less common is probably their complexity, which results in a lower success rate and a higher frequency of complications than in non-occlusive lesions.
Addressing these specific lesions using specific techniques (bilateral access, use of microcatheters, dedicated coronary guidewires, retrograde access, intracoronary imaging) as well as the experience of the operators is key to achieving a high success rate with minimal complications. At UICAR, the success rate exceeds 90%, including highly complex cases, and the patient is discharged within 24 hours.
