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CAD Treatments

If you have coronary artery disease (CAD), you have access to the highest level of expertise right here in Virginia. Our team at VCU Health Pauley Heart Center will help you make informed decisions about your treatment plan – and make sure you feel well-cared for along the way.

Revolutionary treatments relieve symptoms

Modern cardiovascular devices and procedures have transformed the way physicians treat CAD. Patients who once had limited options – or no options at all – now have access to treatments that can significantly change or save lives.

These minimally invasive treatments are sometimes called percutaneous coronary interventions (PCIs). They are safe, effective alternatives to open-heart surgery.

During PCI:

  • Your doctor gently guides a catheter through your main blood vessels until it reaches the congested or blocked coronary artery. The catheter enters your body through a tiny incision in your wrist or groin.
  • Your physician can pass tiny wires, balloons or other devices through the catheter to help open the artery.
  • Your doctor will use X-ray imaging and contrast solution to find the blockage and confirm it’s been cleared.
  • You probably won’t need general anesthesia. In most cases, we use conscious sedation so you’re comfortable and able to interact with your care team. This also ensures prompt recovery after the procedure, with most patients being discharged within 24 hours.

Types of PCI

Pauley Heart Center offers the full range of PCI procedures to treat all degrees of CAD. These include:

  • Angioplasty and stenting – The damaged artery is dilated with a balloon-tipped catheter, then propped open with one or more tiny metallic mesh devices called stents.
  • Atherectomy – A catheter fitted with a tiny drill or laser clears thick, hard plaque inside the artery. This procedure is performed along with angioplasty and stenting.
  • Chronic total occlusion percutaneous coronary intervention (CTO PCI) – This is a complex form of PCI. It’s reserved for people who have had a complete blockage for at least three months (a condition known as chronic total occlusion, or CTO). This procedure entails a markedly higher challenge for the operator, and only few interventional cardiologists in the country are able to treat these blockages with a vast array of techniques and good outcomes. This is due to the fact that no contrast dye flows through the occluded vessel, and therefore the operator has to navigate with very little guidance within the blockage. For this reason, alternative techniques are required, compared with conventional procedures to relieve lesser degrees of blockages. In particular, doctors at VCU Health master several complex techniques, including the retrograde approach, by which the blockage is approached through tiny vessels that originate from the other side of the heart: this technique is performed only by a handful of operators in the country. We are one of the few health systems in Virginia to offer this procedure.
  • PCI with mechanical circulatory support – Some patients with reduced heart function and/or requiring very aggressive revascularization (for example, using atherectomy or on the left main coronary artery) used to suffer high rates of significant complications (e.g., heart attack, severe acute heart failure, and death) when undergoing PCI. Fortunately, for the past few years, VCU Health can offer a revolutionary approach to these cases: interventional cardiologists can use a special pump to support the heart during these delicate procedures. This pump guarantees constant blood flow through the coronary arteries and throughout the body, despite such aggressive revascularization techniques. The pump is typically inserted through the femoral artery (in the groin) and removed at the end of the procedure or shortly thereafter.
  • Ultra-low contrast PCI – Patients with advanced chronic kidney disease are particularly vulnerable to the deleterious effects of contrast dye. For this reasons, alternative techniques, using very limited amount of contrast dye, are required to provide the benefits of coronary revascularization while at the same time preserving kidney function. VCU Health is one of the few institutions in the country offering an ultra-low contrast PCI program, which minimizes the overall amount of contrast dye administered by using sophisticated techniques, including intravascular imaging.

In collaboration with Pauley Heart Center cardiothoracic surgeons, we also treat people for whom surgery is the ideal option, despite the availability of PCI techniques. The type of treatment you’ll need depends on several factors, including your age, medical conditions and the size or density of your blockage. You and your doctor will discuss the benefits and risks of each treatment option to decide which procedure is right for you.

Highly effective therapies for high-risk patients

At Pauley Heart Center, we care for the full spectrum of CAD, from moderate artery obstruction to total coronary occlusion. We often treat patients who:

  • Are considered too high-risk for coronary artery bypass grafting (CABG), a type of open-heart surgery
  • Have been turned down for a stent procedure or have had a stent failure
  • Have severe calcification and require an aggressive atherectomy
  • Have reduced heart function and need a mechanical pump to help with blood circulation during PCI
  • Have advanced kidney disease and can tolerate only minimal amounts of the contrast dye typically used during PCI

If you have other heart problems or medical conditions in addition to CAD, you can rest assured knowing our team works closely with many medical and surgical specialists. Whether you need help managing diabetes, liver disease or cardiac arrhythmia, you’ll find the comprehensive care you need at VCU Health.

Contact Us

For patients

To schedule an appointment with a coronary artery disease specialist at Pauley Heart Center, please call (800) 762-6161, weekdays from 8 a.m. to 5 p.m., or request an appointment online.

For physicians

To refer a patient for further evaluation or potential treatment, please call (800) 762-6161.

Meet our team leader

Lorenzo Azzalini, MD, PhD, MSc, an internationally renowned expert in PCI, leads our minimally invasive CAD and CTO treatment programs. Dr. Azzalini’s specialties are CTO (chronic total occlusions); rotational, orbital, and laser atherectomy; high-risk PCI using mechanical circulatory support devices; left main PCI; bifurcation interventions; and ultra-low contrast PCI in patients with advanced chronic kidney disease.