Advances in Angioplasty Can Prevent Heart Attacks

Richard Skor (pictured) feels great and rarely misses his morning exercise sessions in his backyard pool. Fit and trim at age 74, the retired accountant took up walking through the water years ago to remain active.

During a routine visit to his primary care doctor recently, Mr. Skor casually mentioned that he sometimes felt some muscle tightness in his chest and back, but that it passed after he visited his chiropractor. As a precaution, his doctor, Keila Hoover, M.D, a family health physician with Baptist Health Quality Network, recommended a nuclear stress test. The imaging test, which uses a radionuclear tracer to measure blood flow, yielded unexpected news: three out of four of the arteries supplying blood to Mr. Skor’s heart were seriously blocked.

“It was a complete surprise,” Mr. Skor says. “My blood pressure has always been good. My EKG has always been normal. There were no signs or symptoms.”

Coronary Angioplasty ‘Continues to Evolve’

Mr. Skor is very grateful the blockages were detected before he had a cardiac event. According to the American Heart Association, many of the 785,000 people in the United States who have their first heart attack each year have no warning signs. “My first episode would have been my last,” he says. “I could have been dead.”

To open the blockages, Mr. Skor underwent three minimally invasive procedures performed by Ramon Lloret, M.D., an interventional cardiologist at Baptist Health’s Miami Cardiac & Vascular Institute. Using wires and catheters threaded through small incisions in Mr. Skor’s arm and legs, Dr. Lloret was able to restore healthy blood flow to Mr. Skor’s heart without having to cut open his chest.

Commonly known as coronary angioplasty, the procedure is not a new one, especially at Miami Cardiac & Vascular Institute, which has been at the forefront of minimally invasive approaches to cardiac care since its inception. Noteworthy, however, are the advances in surgical skill, techniques and equipment that benefitted Mr. Skor, who had a 100 percent blockage in one of his arteries and required a hybrid procedure.

“It’s a complicated and sophisticated procedure, and it continues to evolve,” Dr. Lloret says. “The equipment has gotten more specialized. Now we have specially designed micro catheters, better wires and devices that can be positioned more precisely in the coronary vessel wall.”

Although recovery from minimally invasive surgery is easier, it isn’t for everyone. In some cases, cardiac bypass surgery might be a better option. For example, bypass surgery might be used to treat patients who have severe coronary heart disease with the narrowing of the left main coronary artery, those who have poor function in the lower left heart chamber (the left ventricle), or diabetes.

In Mr. Skor’s case, “He had a very good result, and he avoided having open-heart surgery,” Dr. Lloret says. “He avoided the physical trauma of having his chest cut open and of having to go on the heart-lung machine.  In addition, he would have had a wound on his leg where a vein for bypass would have been removed, as well as a recovery of five to seven days in the hospital and the scar that would be left on his chest.”

Quick Recovery

Mr. Skor’s first percutaneous procedure with Dr. Lloret was a coronary angiography to determine more specifically the location and extent of his blockages. A catheter was inserted through a blood vessel in his arm to inject dye into his bloodstream, producing X-rays to help guide Dr. Lloret.

That procedure was followed several weeks later by angioplasty of both arteries on the right side of Mr. Skor’s heart, which were 80 and 90 percent blocked. Dr. Lloret threaded a thin, flexible catheter with a balloon at its tip to the affected arteries. Once in place, the balloon was inflated to compress the impeding plaque against the artery wall, restoring blood flow through the artery. A stent was inserted to help maintain his artery.

Even more sophisticated was the procedure six weeks later to deal with Mr. Skor’s complete blockage in the left anterior descending artery, a condition known as a chronic total occlusion or CTO. To ensure success, Dr. Lloret addressed the blockage by injecting contrast from both directions — the traditional approach in which blood normally flows, also known as antegrade, as well as the opposite direction, threading a second catherer backwards, or retrograde, to reach the blockage through a channel of collateral arteries.

“It’s more complex and challenging. Relatively few interventional cardiologists are performing this procedure,” Dr. Lloret said. “It’s a lot of hard work, but it’s very rewarding for the patients in the end, especially if they get revascularization of their heart and avoid bypass surgery.”

Mr. Skor says he was only mildly sedated and had no discomfort whatsoever in any of the procedures. “It’s amazing,” he says. “You check in, they keep you overnight for observation and you go home the next day.”

He was back on his feet almost immediately. A few nights later he and his wife went out to dinner. Two months later, they travelled to Europe to visit their son and grandchildren who live in London. Mr. Skor participated in prescribed supervised activities in Miami Cardiac & Vascular Institute’s cardiac rehab gym just to be sure his recovery was on track, and he was back in his backyard pool as soon as he got the green light.

“I feel great,” he says, adding he hadn’t noticed that he was slowing down because of the blockages, which typically build up over time. “I have much more energy now because I have better blood flow.”

Last Frontier in Interventional Cardiology 

Although minimally invasive catheter procedures are being used increasingly in cardiac care, the combination of an antegrade-retrograde approach, called the hybrid procedure, is the new method to manage chronic total occlusions (CTOs). Dr. Lloret says. “CTOs are one of the last frontiers in interventional cardiology”.

Mr. Skor’s wife of 44 years, Susan, is happy things are back to normal. When she learned of the extent of her husband’s blockages, she was shocked. But now she can breathe a sigh of relief when her husband enters the pool every day.

“Initially, I was very scared, quite frankly,” she says. “But when I started talking to people, I realized a lot of my friends have gone through similar things with their husbands or their parents.”

She is very grateful for Dr. Lloret’s skill and willingness to address the problem with a minimally invasive approach. “It was amazing that they were able to do that kind of procedure considering the blockages he had,” Mrs. Skor says. “Everyone else I know who had those kind of blockages had open-heart surgery.”

(Photo by Donna Victor)