Loyola University surgeon uses new technique to reopen blockages in coronary arteries

In some heart patients, coronary arteries become so clogged that they are difficult or impossible to reopen with conventional balloon angioplasties.

Dr. John Lopez of Loyola University Health System is using a new angioplasty technique to reopen these tough blockages by going through the "back door."
The technique, called retrograde recanalization, was developed in Japan and is beginning to catch on in centers with advanced expertise in cardiac catheterization. It is a complex procedure that requires new catheters and tools that can pass through arteries less than 1 millimeter wide.

Lopez recently used the technique on Heliodoro Galvan, 55, of Oak Forest, Ill. Before the procedure, Galvan's right coronary artery was completely blocked, causing fatigue and difficulty breathing.

In a conventional angioplasty, an interventional cardiologist inserts a catheter through an artery in the groin and guides it to the front end of the blockage. The catheter is passed through the blockage, and a balloon on the tip of the catheter is inflated to open the artery. The cardiologist typically deploys a stent (wire mesh tube) to keep the artery open.

But in Galvan's case, the front of the blockage was clogged with bone-hard deposits. So Lopez took a different route. He approached the blockage from the back end, which was softer and easier to break through with a catheter.

To reach this back end, Lopez took an alternative route that passed through narrow "collateral" arteries that are 0.5 millimeter to 1 millimeter wide. (These collateral arteries sprouted up after the right coronary artery closed up.)

Before undergoing the procedure, Galvan experienced unusual fatigue. He nearly fainted a few times at his physically demanding job. Spending a day with his grandchildren left him exhausted. And he couldn't run more than half the length of a football field without becoming winded.

Galvan underwent the procedure Aug. 24 and went home the next day. Today, he has much more energy, and can run easily for 5 or 10 minutes without stopping. He walks and jogs three or four miles every other day. He also has improved his diet and lost about 20 pounds.

"I feel a lot better," he said. "Finally, I can go for a run."

Lopez is director of interventional cardiology research and a professor in the cardiology division of the Department of Medicine of Loyola University Chicago Stritch School of Medicine.