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Treatment for Coronary Total Occlusion(100% blockage)
Has anyone been treated for Coronary Total Occulsion(CTO) ? As I understand it, only a few centers in the U.S. have qualified staff to perform the procedure. Is this treatment available at any of the Mayo Clinics(Az, Fl, Mn)? Would like to hear thoughts from those who have considered or have had this treatment. Thank you!
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Hi Jim @thankful
The latest echocardiogram has my husband's EF at 65%, and that is with the CTO. I will have to find out what EF was prior to the cardiac cath procedure. Yesterday would have been a week since he got his stent installed. Did your EF improve after stent? Anna
@caretakermom- Anna, My EF improved, but not according to my cardiologist here where my stent was placed. A year later after I had another Echo I was told by the same cardiologist that there was still no change. That's when I decided to make my appt. at the AZ. Mayo. It was approx. 6 months later that I had my appt. with Dr. Lynch and after that battery of tests he confirmed to me that my EF was more like 45-47 rather than 30-32 that I was being told back home. I've read and been told that in many cases collateral blood vessels will often grow into those areas affected in the heart, but mine either took longer and because of the 100% blockage there was damaged heart tissue that would never receive regeneration.
An EF of 65 is totally normal. It would be interesting to know what your husbands was prior to the stent. Jim @thankful
Jim@thankful. I should be able to find out what my husband EF was prior to stent, because there was 1 previous Nuclear test/Echo done in the first part of 2019 with result coming back "normal". Then in April/May of this year the Echo result was abnormal. However, due to other issues, my husband was not able to get the cardiac cath done right away. At that point, he still had no symptoms such as chest pain so the cardiologist said it was Ok to wait. My husband do the nuclear stress test and Echocardiogram because those must be done annually in order to qualify for transplant. I'm just very surprised that the CTO did not show up in the stress test at the 2019 stress test!!
Jim @thankful, I'm a little confused. Your comment above suggests the stent to treat the CTO was done by your local cardiologistl? And you went to Mayo to get a second opinion on your EF after the stent was installed? Did you seek any treatments at Mayo other than running a battery of tests? We are hoping Mayo can help treat husband's CTO, if need to be.
@caretakermom- Anna, If I had the time and was aware of my problem I would have definitely gone to Mayo, but as I said I only found out after suffering my HA. The main reason for the trip to the Mayo as I said was to get an 2nd opinion because I kept being told that my EF had not improved.
I had my HA in May of 2014 and went to the Mayo in April of 2018. The battery of tests I had there confirmed to me that my EF was far better than I had been told here by my Cardiologist over a 4 year period. Jim@thankful
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1 ReactionJim @thankful. Mayo pre kidney transplant nurse called today. They have reviewed all of husband's cardio records for the past 6 months. They are telling us he needs to get the CTO fixed before he can be qualified for a kidney eval. The thing I'm worried about is cardiologist says the PCI (Percutaneous Coronary Intervention) procedure success rate is a mere 30%. PCI is preferable because it is the least invasive as opposed to open heart surgery which has a much higher success rate to fix the blockage. So conflicted as to what to do. Cardiologist doesn't feel we need to address the CTO at this moment and gives the impression that it's not worth it to try PCI because of low success rate, so just leave as is. On the other hand, it would be great if husband can get a new kidney so that he could live a somewhat normal life but in order to do that, he has to have open heart surgery!! It sounds like cardiologist is saying husband can live a good life without having to do anything about the CTO, because the collateral blood vessels have formed.
Jim, did you ever have to have open heart surgery? This sounds very scary to me!
I don't have the answer for you and this sounds like an extremely trying and complicated situation. However, that fact that you are working with Mayo seems to be very hopeful as the departments are known to work together better than most( or all) other places. Definitely see a cardiologist at Mayo. Ask for a proposed plan for both items plus anything else needed. Did they give you a plan?
I would make sure the Kidney doctor hears what the Cardiologist is saying about this cardiac issue possibly not being a priority if your understanding is correct, or understand his/her perspective if they see it differently.
This may help you get to the best plan. Mayo should collaborate appropriately between departments to give you the best plan. I would strongly suggest seeing a doctor of each type you need at/while at Mayo.
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1 Reaction@caretakermom- I never had open heart surgery. I would absolutely trust the Mayo Team of Doctors. Can you talk with a Mayo Cardiologist about this? Jim@thankful
@thankful, I hope you had a great thanksgiving!! Here is the update. Husband's cardiologist will attempt to fix the CTO by installing a stent. As mentioned in my earlier comment, the success rate is a mere 30% and our cardiologist does not recommend a bypass because it would be "overkill". Naturally, Mayo Clinic kidney transplant wants all cardiovascular disease fixed before they would even consider the patient for a kidney evaluation. So as it stands now, we will have our cardiologist perform an angioplasty and see what happens. If he can clear the blockage then my husband is good to go for kidney transplant eval at Mayo Az. If not, we will seek a second opinion at Mayo Az. I have made a appointment for the third week of Feb 2021, to consult with a Mayo Cardiologist. I was told the consulting cardiologist is NOT the interventive cardiologist who will perform the procedure. Dr. John Lynch has been assigned to my husband. Is this the same Dr. Lynch that you saw?
We were also told that NO visitors are allowed in the hospital because of COVID. The patient has to be tested for COVID at Mayo and must arrive 2 days prior to appointment. The first 2 days will be testing for COVID and if negative, we can proceed with appointment. So that means I will not be able to go to the appointment with husband. I did, however, request the initial consultation be done by video. And I sure hope Dr. Lynch can schedule all tests on the same day so that we do not have to stay too long in Az. My husband still works full time and very difficult for him to take time off. Since his kidney failure in Nov 2018, he has had to take much time off for surgeries and various doctor appointments and he is running out of PTOs at work. Most of procedures and surgeries he has had in the past 2 years are all for transplant clearances and have burned thru his PTOs!! I very much hope that our UCLA cardiologist is successful in fixing the CTO. If not, then I sincerely hope that Mayo can help resolve the CTO without having to resort to doing a bypass, which our current cardiologist says he DOES NOT recommend bypass for this kind of blockage. Cardiologist says husband can live a long life without having to fix the CTO, because the collateral blood vessels are supplying adequate blood supply(EF is 65%)Would be interesting to hear what Mayo has to say, if we need to seek a second opinion.
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1 ReactionWhy not have his heart advised and possibly addressed at Mayo?