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Unblock my heart

Toronto, July 4, 2014

By Kaylea Forde and Geoff Koehler

Physicians treat a complex artery blockage
Dr. Simon Walsh, a guest faculty member; Dr. Christopher Buller, St. Michael’s director of cardiac catheterization and intervention; and Dr. Basem El-Barouni, an advanced trainee; treat a complex coronary artery blockage during an international course held at the Li Ka Shing Knowledge Institute last June. (Photo by Yuri Markarov)

When coronary arteries are narrowed because of plaque buildup and blood flow to the heart is limited, cardiologists use a combination of medicine and stents to reopen them in a procedure called percutaneous coronary intervention.

But when a coronary artery is completely blocked – known as a chronic total occlusion – percutaneous coronary interventions don’t typically work and patients are forced to choose between putting up with symptoms that limit activity or undergoing open-heart surgery.

Drs. Christopher Buller and John Graham lead a team at St. Michael’s that is changing this and developing a new set of advanced percutaneous coronary intervention techniques that may largely solve chronic total occlusions.

The team develops and delivers advanced therapies for patients with the most complicated forms of coronary artery disease, especially for those who have been turned down for treatment at other centres.

“St. Michael’s has built the largest program in Canada for advanced chronic total occlusion treatment,” said Dr. Buller, director of cardiac catheterization and intervention. “Delivering breakthrough percutaneous coronary intervention treatments for complicated blockages is a big part of our Heart and Vascular Program.”


St. Michael’s is also heading a national trial that might make treating the more routine blockages easier. Dr. Buller is the principal investigator of the trial, which will assess the potential benefits of a new drug that may soften blockages over 24 hours. If the drug safely softens the plaque, it may make it easier and faster in some patients to reopen the artery and restore blood flow.

The most common technique at St. Michael’s for treating fully blocked arteries uses two catheters, each approaching the blockage from opposite ends. This technique takes about twice as long as a routine percutaneous coronary intervention.

St. Michael’s treats more than 160 patients with chronic total occlusions each year and is internationally recognized for its excellence and its contribution to the field.

“Teaching is also crucial to our program,” said Dr. Buller. “Because we see so many cases, we’re able to offer a training course every June where we live stream six complex chronic total occlusion cases. Interventional cardiologists get an interactive, educational experience that can’t be conveyed through journal articles or text books.”

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.