Coronary artery disease, or CAD, affects millions of people and can make everyday life more challenging. As blood flow to the heart becomes restricted, symptoms such as chest pain, shortness of breath and fatigue may develop, limiting activity and overall quality of life. For some patients, CAD is especially complex, and traditional treatments like standard stenting or bypass surgery may carry higher risks; some patients with CAD are told there are no more options for opening up their blocked arteries.
At Tufts Medicine, interventional and advanced heart failure cardiologist Mohammed Aslam, MD, Director of Acute Mechanical Circulatory Support at Tufts Medical Center and Assistant Professor at Tufts University School of Medicine, specializes in using Complex High-Risk Indicated Percutaneous Coronary Intervention, or CHIP, to treat patients with severe and complex coronary artery disease who may have limited treatment options. Here's what you should know:
What is Coronary Artery Disease (CAD)?
CAD the most common type of heart disease. It occurs when the blood vessels that supply the heart muscle become narrowed or blocked by a buildup of plaque made up of cholesterol and other substances. Over time, this reduces the amount of oxygen-rich blood reaching the heart.
CAD often develops gradually and may not cause noticeable symptoms at first. As the disease progresses, reduced blood flow can increase the risk of serious complications such as heart attack or heart failure. CAD can be managed with medications, lifestyle changes and routine stenting procedures or bypass surgery. However, a number of people develop complex coronary artery disease that requires more advanced care and techniques.
That's where Complex High-Risk Indicated Percutaneous Coronary Intervention, known as CHIP, can play an important role.
What is CHIP (complex high-risk PCI)?
CHIP is an advanced form of percutaneous coronary intervention (PCI; referring to opening the arteries in the heart) designed for patients with complex, high-risk CAD, such as those with 100% blocked arteries. This is also referred to as chronic total occlusions (CTO). Like other catheter-based heart procedures, CHIP/CTO interventions use thin tubes guided through blood vessels to reach blocked coronary arteries. What sets these techniques apart is the level of planning, expertise and specialized technology involved.
"The techniques involved in performing CHIP/CTO interventions allows us to treat patients with very complex coronary disease who previously had few or no good options," says Dr. Aslam. "It combines advanced tools and techniques to safely restore blood flow when standard procedures may not be enough, offering patients relief when they have been told their arteries cannot be fixed."
CHIP/CTO procedures often use specialized devices to treat heavily calcified arteries, long or complete blockages and disease affecting critical areas such as the left main coronary artery.
How can CHIP/CTO procedures help people living with coronary artery disease?
Many people with advanced CAD are considered high risk for traditional treatments due to factors such as:
- Multiple or 100% coronary artery blockages
- Heavily calcified plaque
- Reduced heart pumping function
- Prior bypass surgery or prior stents
- Other medical conditions such as kidney disease or diabetes
For these patients, open-heart surgery may be too risky and standard angioplasty is unable to open up all the blockages, causing continued symptoms or reduced heart function.
"The goal of these specialized is to relieve symptoms and improve quality of life while minimizing risk," Dr. Aslam explains. "For the right patient, it can significantly improve how they feel and function day to day."
By improving blood flow to the heart muscle, CHIP/CTO interventions can help reduce chest pain, improve breathing and increase stamina.
Who is a candidate for CHIP or CTO procedures?
Patients who may benefit from these specialized procedures often include those who:
- Have complex or severe coronary artery disease (CTO)
- Are at higher risk for coronary artery bypass surgery
- Have persistent symptoms despite medication
- Have coronary anatomy that makes standard PCI difficult
- Have reduced heart function or heart failure
At Tufts Medicine, CHIP/CTO candidacy is determined through a multidisciplinary heart team approach, bringing together interventional cardiologists, cardiac surgeons and other specialists to evaluate each patient carefully.
"Performing these complex interventions is never a one-size-fits-all solution," says Dr. Aslam. "We take time to understand each patient's condition, overall health and goals before recommending this approach."
What patients should know about CHIP and CTO procedures
Although CHIP/CTO procedures are complex, they are still minimally invasive and often involve shorter recovery times compared with open-heart surgery. Procedures are performed in specialized cardiac catheterization labs by experienced teams trained in high-risk PCI.
"For many patients, the most important thing is knowing there may still be an option," Dr. Aslam says. "CHIP/CTO interventions can offer hope to people who were once told there was little more we could do."
Next steps for patients with complex CAD
If you or a loved one has coronary artery disease and continues to experience symptoms despite medication or prior procedures, talk with your cardiologist about whether a referral to a specialized heart team may be appropriate.
CHIP and CTO interventions are helping expand treatment options for patients with complex CAD, offering a path toward improved heart function, symptom relief and quality of life.
