Center for Complex Coronary Interventions & Redo Heart Surgery

Overview

Cleveland Clinic’s Center for Complex Coronary Interventions provides treatment options to those who have more advanced or complicated coronary disease. These include patients with:

• Difficult to treat blockages:
  • Total coronary artery blockage (occlusion)
  • Calcification blockage that requires atherectomy
  • Blockage at a side branch of a coronary artery (or bifurcation blockage)
• A history of prior treatments such as
• Several unsuccessful angioplasty or stent procedures
• Prior coronary artery bypass surgery
• Factors causing them to be higher risk for standard treatment
  • Poor heart function (low ejection fraction) due to prior heart attacks
  • Other medical conditions (multivessel disease, severe valve disease, or other medical conditions) that increase the risk of treatment complications
  • Multiple blockages and are not good candidates for bypass surgery
• Coronary artery disease and are interested in a hybrid (minimally invasive coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI)) treatment approaches
• Severe symptoms despite having all standard treatments.
• Symptoms of coronary ischemia but have no signs of large vessel blockages

Cleveland Clinic cardiologists and heart surgeons work together with other specialists as needed to develop an individual plan of care that offers you the best outcomes possible.

Why choose Cleveland Clinic for your Care?

Cleveland Clinic Interventional Cardiologists perform over 1700 interventional coronary procedures each year. Our outcomes for treatment of coronary artery disease speak for themselves. Please review our facts and figures, and if you have any questions, don’t hesitate to ask.

Director of the Center for Complex Coronary Interventions

Stephen Ellis, MD

Complex Coronary Intervention Care

Cleveland Clinic’s complex coronary intervention team uses a variety of techniques and stenting options to provide treatment to patients with even the most complex blockages. In spite of treating the most complex patients, our outcomes are better than the rates at comparable hospitals, with less vascular complications, emergency surgery, stroke, or death.

• Learn more about our outcomes

 

Intervention Team

• Christopher Bajzer, MD
• Leslie Cho, MD
• Stephen Ellis, MD
• Samir Kapadia, MD
• Amar Krishnaswamy, MD
• Michael Lincoff, MD
• Rishi Puri, MD, PhD
• Grand Reed, MD
• Laura Young, MD
• Khaled Ziada, MD

Other medical specialties

Experts in other medical specialties are consulted as needed to help manage the care of patients with complex medical problems, such as kidney disease, blood conditions and others.

Restenosis Brachytherapy Intervention Care

Cleveland Clinic doctors have been using local radiation therapy (brachytherapy) since 1998 to treat patients with recurrent blockages in the heart arteries. It is one of the few centers in the country to offer the treatment, and our experts perform about 50-60 procedures per year with excellent outcomes. Patients typically have 2 or more reblockages at the stented site. Procedural risks are small (no deaths to date, 0.6% of patients have had a heart attack due to the procedure) and the risk of reblockage after the procedure drops from an expected 50% to 27% at one year after treatment.

Intervention Team

• Christopher Bajzer, MD
• Leslie Cho, MD
• Stephen Ellis, MD
• Samir Kapadia, MD
• Jaikirshan Khatri, MD
• Amar Krishnaswamy, MD
• Michael Lincoff, MD
• Rishi Puri, MD, PhD
• Grant Reed, MD
• Jacqueline Tamis-Holland, MD
• Laura Young, MD

Radiation Oncology Team

• Jay Ciezki, MD
• Sheen Cherian, MD
• Jacob Miller, MD

References

• Martin B. Leon, M.D., Paul S. Teirstein, M.D., Jeffrey W. Moses, M.D., Prabhakar Tripuraneni, M.D., Alexandra J. Lansky, M.D., Shirish Jani, M.D., S. Chiu Wong, M.D., David Fish, M.D., Stephen Ellis, M.D., David R. Holmes, M.D., Dean Kerieakes, M.D., and Richard E. Kuntz, M.D, NEJM 2001, Localized Intracoronary Gamma-Radiation Therapy to Inhibit the Recurrence of Restenosis after Stenting, N Engl J Med 2001; 344:250-256 January 25, 2001 DOI: 10.1056/NEJM200101253440402
  
  
• Häfeli, U. O., Roberts, W. K., Meier, D. S., Ciezki, J. P., Pauer, G. J., Lee, E. J. and Weinhous, M. S. (2000), Dosimetry of a W-188/Re-188 beta line source for endovascular brachytherapy. Med. Phys., 27: 668–675. doi:10.1118/1.598928
  
  
• Stephen G. Ellis, Charles D. O'Shaughnessy, Steven L. Martin, Kenneth Kent, Thomas McGarry, Mark A. Turco, Dean J. Kereiakes, Jeffrey J. Popma, Mark Friedman, Joerg Koglin, Gregg W. Stone, ; Two-year clinical outcomes after paclitaxel-eluting stent or brachytherapy treatment for bare metal stent restenosis: the TAXUS V ISR trial, European Heart Journal, Volume 29, Issue 13, 1 July 2008, Pages 1625–1634, https://doi.org/10.1093/eurheartj/ehn231

High Risk Intervention Care

Patients who are considered high risk, such as those who have very poor heart function requiring intervention to the left main coronary artery or multiple vessels; or those that are in cardiogenic shock due to a heart attack, at time of procedure; may benefit by percutaneous left ventricular support during and sometimes after interventional procedures. Our experts will talk to you about this type of care, if needed.

Intervention Team

• Christopher Bajzer, MD
• Stephen Ellis, MD
• Samir Kapadia, MD
• Jaikirshan Khatri, MD
• Amar Krishnaswamy, MD
• Ravi Nair, MD
• Rishi Puri, MD, PhD
• Grant Reed, MD

Chronic Total Occlusion (CTO) Care

Treating patients with total coronary occlusions, or coronary arteries that have been blocked for at least 3 months, is a subspecialty within Interventional Cardiology. Few cardiologists are fully trained to treat patients with these challenging blockages. National success rates are around 60%.

Cleveland Clinic’s Complex Coronary Intervention Team physicians are fully skilled in the 3 technical approaches needed for high success rates:

• Going forward through the blockage
• Going around the blockage and reconnecting with the artery
• Going backwards through the blockage using the body’s collateral vessels (those that are alternative smaller vessels near the blockage)

We treat more than 120 patients for CTO each year, and our success rates are about 85%, despite the fact that many of our patients have had unsuccessful treatment at other hospitals.  Cleveland Clinic participates in several National Registries to study the best treatment approaches for these patients.

Intervention Team

• Stephen Ellis, MD*
• Jaikirshan Khatri, MD*
• Laura Young, MD

References

• Ellis SG, Burke N, Murad MB, Graham JJ, Badawi R, Toma C, Meltser H, Nair R, Buller C. Whitlow PL, CAPS Group. Predictors of Successful Hybrid-Approach Chronic Total Coronary Artery Occlusion Stenting; An Improved Model With Novel Correlates. JACC: Cardiovascular Interventions, vol. 10 no. 11 1089-1098 DOI: https://doi.org/10.1016/j.jcin.2017.03.016
  
  
• Khatri J¹, Abdallah M², Ellis S². Management of coronary chronic total occlusion. Cleve Clin J Med. 2017 Dec;84(12 Suppl 3):27-38. doi: 10.3949/ccjm.84.s3.03

Coronary Spasm & Microvascular Disease Care

Patients with coronary spasm or microvascular disease are often misdiagnosed and do not get the proper treatment. This is often because special procedures are needed to make a correct diagnosis. . Cleveland Clinic has a long history of treating these patients that dates back to the pioneering work by Dr. Fredrick Heupler in the early 1970s. Cleveland Clinic is one of the few centers in the country that offers intracoronary flow reserve (CFR) and ergonovine testing to make these diagnoses.

Learn more on microvascular coronary disease (MCD)

Intervention Team

• Scott Cameron, MD
• Leslie Cho, MD
• Stephen Ellis, MD
• Khaled Ziada, MD

References

• Heupler, FA. Syndrome of symptomatic coronary arterial spasm with nearly normal coronary arteriograms. Am J Cardiol.1980 Apr;45(4):873-881.

Redo Coronary Artery Bypass Surgery

Patients who have had prior bypass surgery may require additional heart surgery in the future. Cleveland Clinic’s coronary artery bypass surgery program is the largest in the country for reoperations. Twelve percent of patients who have coronary artery bypass surgery at Cleveland Clinic are patients who have had the surgery in the past. Despite the potential for increased risk during reoperations, our surgeons maintain a low mortality rate for these procedures (0% in 2016).

In addition, Cleveland Clinic heart surgeons have vast experience with patients who have complex medical history and/or poor left ventricular function.

Because, our cardiologists and cardiovascular surgeons work together, patients are provided the best procedure for their specific medical history and anatomy.

• See our State of the Art Coronary Artery Bypass Surgery Center to learn more.

Make an Appointment

The Center for Complex Coronary Interventions is located at Desk J2-3, on the second floor of the Miller Family Heart, Vascular & Thoracic Institute (J Building).

To make an appointment, please call: Call Toll-free 800.223.2273, ext. 46697 or submit an online request.

Physician Referrals - Call 800.659.7822 (or call physician’s office directly).

Your Appointment

If your scheduled appointment is at least one week away, you will be asked to send in a copy of your medical records, including a medical history, test results and films (echocardiogram, ultrasound, chest X-ray, MRI, CT). All information should be sent in the same package (clearly marked with your name and address) via Airborne Express, Federal Express, or certified U.S. mail (make sure you have a tracking number) to the physician you will be seeing at Cleveland Clinic.

Mail your records to:

Physician Name
Cleveland Clinic
Desk J2-3
9500 Euclid Avenue
Cleveland, OH 44195

If your scheduled appointment is less than one week away, please bring your records to your appointment.

Traveling to Cleveland Clinic

To help make your visit to Cleveland Clinic as easy as possible, please visit:

• Information on travel to the Miller Family Heart, Vascular & Thoracic Institute.

What to expect during your appointment

You will meet with a nurse or physician assistant (PA) who will collect information about your medical history, symptoms and test results, and enter your information into your electronic medical record. This will help the doctor during your exam.

You may need blood and imaging tests, such as an electrocardiogram, echocardiogram, MRI or CT scan. These tests help diagnosis your condition and create your plan of care. A cardiologist from the Complex PCI Center will review your records, take a medical history, perform a physical exam, and, if needed, consult with other physicians in the Center to discuss your condition. If you need to meet with one of the multidisciplinary specialists, we will try to schedule your appointment within a day to limit your travel to and from Cleveland Clinic.

How long will you need to stay at Cleveland Clinic?

Plan on spending 1 to 2 days in the Cleveland area. You may need to stay longer if a treatment is scheduled at the time of your visit.

Follow-up

Your doctor will talk to you about your plan for follow-up care.

More Information

If you need more information, contact us, chat online with a nurse or call the Miller Family Heart, Vascular & Thoracic Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.