Flagship Programs

Many patients with severe coronary artery disease (CAD) are told they have no treatment options or must undergo invasive surgery to open a blocked artery. For a growing number of patients, rapid advances in percutaneous coronary intervention (PCI) offer complex patients a new treatment option to feel better.

Complex Higher-Risk Indicated Procedures (CHIP) are percutaneous coronary interventional procedures that restore blood flow to the heart to improve debilitating symptoms. Our team of interventional cardiologists specializes in these complex coronary interventions. CHIP relies on an understanding of the unique procedural challenges for each individual and uses a multidisciplinary approach to care for these diverse, sometimes critically ill patients. We have experience with all of the latest treatment modalities. The goal is an improved quality of life for the patient. While the outcomes are patient-focused, the involvement of family members is important. Communication with all parties involved is paramount.

Yale Cardiovascular Medicine has one of the most prolific complex higher-risk procedure programs for recanalization of coronary chronic total occlusion (CTO), which is the complete occlusion of a coronary artery. The team performs over 100 coronary CTO PCI procedures annually with a variety of innovative technologies and techniques to optimize success, safety, and clinical outcomes for patients with severe coronary artery disease. All procedures are guided by intravascular imaging with intravascular ultrasound (IVUS) or optical coherence tomography (OCT). Our procedures are performed by two experienced operators to enhance the success rates and improve safety.

These methods include:

• Use of specialized guidewires and crossing devices
  
• Antegrade dissection re-entry (ADR)
  
• Retrograde techniques including controlled antegrade retrograde tracking methods (CART) and reverse CART

Yale supports a variety of national and international meetings, and educational programs to assist physicians with methods and patient selection for CTO PCI. Yale serves as a referral center for this condition. The current success rates average 90% without excluding a patient on the basis of complex coronary anatomy. Current efforts include the development of new devices to improve procedural success, delineation of patient outcomes, and standardization of techniques and education for CTO PCI.

Other advanced therapies offered in the Complex Coronary Intervention program at Yale include:

• Atherectomy: rotational, orbital, laser
• Intravascular lithotripsy with Shockwave
• Advanced mechanical circulatory device support
• Bifurcation and trifurcation stenting procedures
• Brachytherapy
• Complex transradial coronary intervention including biradial interventions
• Unprotected left main and complex multivessel PCI

The group is involved in several clinical trials at Yale to evaluate cutting-edge treatments for complex coronary artery disease.

For more information about Complex Coronary Interventions, please call 203-785-2444.