Cardiology's Final Frontier: Confronting CTO
One of the joys of being a physician is simply doing what you do: the details of sorting through the complexities of ailments, evaluating medications, exploring the sinew of the body, the interwoven lines that carry the blood, saving a life.
Sometimes the business of what you do gets lost in the hubbub of money, and politics, and healthcare plans, but it’s nice to think about the purity of being a physician: and maybe being part of something that pushes you further into evolving realms of the science of what you do. Or at least spur some debate.
Like the place where Dimitri Karmpaliotis, MD, seems to be right now.
At 39, he is an interventional cardiologist at Piedmont Heart Institute, in Atlanta, GA, where he performs retrograde and antegrade angioplasty, loves it, and sees it expanding in the future in cardiac care. It is for the treatment of complex chronic total occlusion (CTO), and has been dubbed by some academics as being in the “last frontier” of cardiac intervention. Chronic occluded arteries account for 20 to 30% of coronary diseases, experts say.
Karmpaliotis’ specialty is maneuvering the arteries, declogging them with wires and a specificity that he says can be a major tool to help potentially hundreds of thousands of people. These are patients who, for example, had already undergone one bypass surgery operation, and their bypass grafts are failing and need more intensive doctor's care.
Piedmont Heart Institute is only one of about a dozen hospitals nationwide that perform more than 20 retrograde angioplasty cases a year for the treatment of CTO.
It’s an interesting time for Karmapliotis’ field. Piedmont, for instance, is considering doubling its CTO treatment at a time the treatment strategy has not been fully embraced in the U.S., although academic journals note considerable advances, with some criticism. The procedure is extremely popular in Japan, where it is considered home to the foremost experts in retrograde and antegrade angioplasty.
In June, Karmpaliotis was one of five U.S. cardiologists to attend the 2010 Japanese CTO Club conference. Japan is home to the foremost experts in retrograde and antegrade angioplasty. Karmpaliotis says the procedure developed in Japan where patients have been generally reluctant to have bypass surgeries and where cardiologists believe in complete cardiac revascularization.
“In the spectrum of what we do [they are] the most complex, difficult, and fascinating cases,” he says of antegrade or retrograde angioplasty. “One reason it's so complicated is that the artery is closed for a long time, it’s as hard as a rock. If you don’t do it, you don’t get good at it. It’s a different beast than traditional angioplasty.”