Percutaneous Coronary Intervention (PCI)

Percutaneous coronary intervention (PCI) has in the past decades helped millions of patients with coronary artery disease (CAD), often preventing the need for open heart surgery.

PCI candidates are those patients who experience symptoms such as chest pain and are either at risk for impending heart attack or suffering from one.

During PCI a wire is passed through the blockage via catheters placed through the peripheral vessels. Once the wire has crossed the lesion, a balloon is advanced on it and inflated at the site of the lesion to open the blockage. In most cases, a stent (a metal scaffold) is deployed to prevent recoil and reocclusion of the vessel.

One of the most challenging types of coronary lesions to treat with PCI is chronic total occlusion (CTO). These types of lesions have been closed for more than three months. In such cases, patients do not have a heart attack, because other heart vessels develop back channels (collaterals) to feed the affected area. However, collaterals are never as sufficient as the open native artery, and patients can remain symptomatic despite medical intervention.

Furthermore, patients can be even more vulnerable if the donor vessel closes, as the magnitude of the heart attack will be much larger since the artery supplies two different heart territories.

Traditionally, CTOs have been difficult to open via traditional PCI techniques. The main reason for this is that when an artery is closed for a while it becomes calcified, making it nearly impossible to pass the convention PCI wires through. The longer the artery has been occluded and the longer the occlusion have a direct correlation to the difficulty of opening it. However, there are methods, which have been perfected over the past decade, to help skilled surgeons open these arteries when indicated and posing less risk to the patient.

These methods involve the use of specialty wires, microcatheters and other devices to either plow through the lesion, go underneath and reenter distally or go through the donor collaterals to reestablish flow.

Dr. Yazdani started the CTO program at INOVA Heart & Vascular in 2012 after mastering all of these techniques. Since then, he has performed the greatest number of successful CTO procedures in the Northern Virginia area.