CHIP/CTO Program

Innovative Care for Complex Coronary Artery Disease

The Sands-Constellation Heart Institute at Rochester Regional Health offers a leading-edge, innovative approach to treating complex coronary artery disease. Our interventional cardiologists are highly skilled in treating complex high-risk indicated patients (CHIP), including patients with chronic total occlusions (CTO). If you are a higher-risk patient or have the symptoms of complex coronary disease, our program will focus on restoring blood flow to your heart and easing your symptoms in the most minimally invasive way possible. 

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What is CHIP?

CHIP refers to a patient that has symptomatic complex coronary artery disease and requires complex intervention, especially when surgery is not an option. During rest or exertion, a patient with complex coronary artery disease may experience:

  • Chest pain, pressure, or tightness
  • Dizziness
  • Fatigue
  • Nausea
  • Pain in the upper body or arm
  • Rapid or irregular heartbeat
  • Shortness of breath 

The following complex coronary interventions may be necessary to relieve your symptoms and blockage:

  • Rotational Atherectomy - a procedure that uses a tiny rotating cutting device to open a narrowed artery and improve blood flow for those who have tough blockages
  • Orbital Atherectomy - this procedure is an alternative option for drilling through blockages in your arteries
  • Laser Atherectomy - this procedure utilizes a catheter that emits high energy light (laser) to unblock your artery
  • Intracoronary Lithotripsy - by integrating lithotripsy into a modified balloon catheter, your surgeon will prepare, deliver, and treat calcified arterial blockages by delivering ultrasonic energy through your arterial wall
  • Percutaneous Left Ventricular Assist Device - this mechanical pumping device, inserted with the help of a catheter, is designed to help your heart pump more blood
  • Bifurcation Stenting - this stenting technique helps to treat narrowing in a main coronary artery and any adjoining side branch vessels

These procedures may be needed to open a narrowed or blocked artery. They are typically used to keep you stable during the intervention and to ensure that the stents that are placed remain open for a long time.

Our fellowship-trained Sands-Constellation Heart Institute Interventionalists can accurately diagnose and perform your complex coronary interventions in offices throughout Western New York. Learn more about our Interventionalists, and find a provider close to home: 

What are Chronic Total Occlusions?

CTOs are blockages of your heart that have been present for three or more months. A type of heart disease, these blockages are caused by plaque or severe build-up of fatty deposits or calcium within your arteries. When your heart does not receive enough blood, you may experience chest pain, shortness of breath, or a heart attack.

These arterial blockages are caused by plaque (severe build-up of fatty deposits or calcium) within your arteries. When your heart does not receive enough blood from the blocked coronary, you may experience chest pain, trouble breathing, and tiredness. 

Technology for treating CTOs continues to advance, especially for those at higher risk. CTOs are quite common, occurring in nearly 20% of patients with coronary artery disease. With the help of successful intervention, patients typically experience immediate and lasting symptom relief.

How is CTO Treated?

For many years, people with a CTO were treated with coronary artery bypass grafting (CABG), or open-heart surgery, as these were the only available treatment options. Now, however, there are minimally-invasive treatment options available, with success rates close to 90%.

Our CTO Program utilizes a minimally invasive technique called percutaneous coronary intervention, or angioplasty, to treat your blocked artery. Your cardiovascular interventionalist will guide a catheter with various wires to cross the chronically occluded vessel, sometimes having to use a collateral vessel. Once across, then balloons can be advanced over a wire and inflated to open the artery. A stent or stents are then placed. This approach is used to create a wider opening for your arteries to restore your blocked blood flow.

There is a slightly elevated risk of complications, but in most cases, the benefits far outweigh the risks. The risks include:

  • Kidney damage from excessive intravenous iodinated contrast
  • Bleeding at the puncture site
  • Damage to the blood vessel at the puncture site
  • Heart attack
  • Small tear in the lining of your artery
  • Sudden closure of your coronary artery
  • Skin injury from excessive radiation

These risks are similar to those of a more routine angioplasty.

Your CTO Interventionalists

Our CTO interventionalists are experienced in treating patients with complex CTOs. They are supported by knowledgeable noninvasive cardiologists, surgeons, specialists, nurses, and other specially-trained staff members, who work together to make sure this is the right treatment for you.

Our collaborative approach allows us to provide the most well-rounded, thorough care in the region. Meet Our Team!

Our Team