Recanalisation of a chronic total coronary occlusion

A chronic total occlusion is a heart artery that has been completely blocked for more than three months. The heart often develops small back-up vessels (collaterals) that partly compensate, but they are rarely enough during exertion: the patient may experience angina, breathlessness or fatigue. Recanalisation involves crossing the occlusion with very fine, specialised guidewires, then dilating the artery and placing stents. The cardiologist may advance in the direction of blood flow (antegrade approach) or, if necessary, travel through the collaterals to reach the occlusion from the other end (retrograde approach). Two arterial accesses are often used to inject contrast from both sides, at the wrist and/or the groin. This procedure is offered when symptoms persist despite well-conducted medical treatment and tests show that the territory supplied by the blocked artery is still alive but short of blood. It is a long and technically demanding procedure, decided after discussing the expected benefits and risks with the patient, and taking the surgical alternative into account. At Clinique Pasteur Tunis, these recanalisations are performed by interventional cardiologists trained in these techniques, in a latest-generation catheterisation laboratory, with a cardiac intensive care unit on site.