Roger Olson: Chronic Total Occlusion

Living in Cass County near Remer in Northern Minnesota’s lake country, Roger Olson loves the natural beauty of the area. He enjoys hunting, fishing and doing chores and maintenance around the large property and home he shares with Jean, his wife of 54 years. But starting in August 2017, Roger’s shortness of breath, along with increasing and persistent chest pain as a result of coronary artery disease, seemed destined to hinder his enjoyment of those activities for the foreseeable future. 

It wasn’t until a year later when Roger, 75, finally found relief from his chest pain, thanks to the cardiologists at Minneapolis Heart Institute® at Abbott Northwestern Hospital. In early August 2018, under the direction of interventional cardiologist Dr. Emmanouil Brilakis and his team, Roger had a successful chronic total occlusion–percutaneous coronary intervention (CTO-PCI) procedure to open the long-standing blockage in his left anterior descending coronary artery.

After the nearly eight-hour surgery, Roger said, “I woke up and felt wonderful and I’ve felt fine ever since. I told Dr. Brilakis, ‘I don’t know what you did, but it seems to work fine.’ There was a lot of work to be done and apparently he got it done, because I felt like a new person the next day.”

Roger had developed coronary artery chronic total occlusion (CTO), which is complete or almost complete blockage of a coronary artery for 30 days or longer. Coronary CTO is caused by a heavy build-up of atherosclerotic plaque within the artery, resulting in a significant decrease in blood flow to the heart. CTO can cause chest pain, pressure or tightness (angina), shortness of breath, and/or dizziness or fatigue. 

Roger had been referred to Dr. Brilakis by his cardiologist in Duluth, who recognized the complexity and seriousness of Roger’s heart condition. Roger had previously undergone open heart surgery (triple coronary artery bypass) in September 2017 to treat several blockages. He initially felt better; however, within two months, another blockage developed in his left anterior descending artery, and he had a stenting procedure that November. While Roger felt well over the winter, by spring, his chest pain had returned. Initially, a single nitroglycerin tablet would alleviate his pain, but by August of 2018 his symptoms escalated and he needed to take four or five tablets for pain relief.

“My doctor explained that Dr. Brilakis was doing things that my case would probably benefit from,” said Roger. “Meeting Dr. Brilakis, I immediately decided that this guy is the guy.”

The CTO-PCI procedure that Roger underwent is minimally invasive (no open-heart surgery), but requires extensive technical expertise. In the past, total coronary artery blockages have been difficult to clear with interventional procedures. Now, with the advent of advanced technology and innovative percutaneous techniques (performed through a needle stick through the skin), interventional cardiologists are improving the outcomes of percutaneous coronary intervention (PCI), making it a rewarding option for some patients who are experiencing symptoms related to their CTO. Interventional cardiologists now are able to gently steer special guide wires and catheters across the blockages. New technology makes fine movement of the guide wire tip much easier to control than in the past. 

A few days after his heart procedure, Roger’s oldest son shared his heart’s “before” and “after” coronary angiogram images with his siblings. He compared his dad’s “before” heart artery images to a dried-up river in the summer, and the “after” image to the Nile River flowing freely.

“Of course, that was an overstatement, but the difference between the two pictures is pretty substantial. It was wonderful to see how much more blood was coming in to my heart,” said Roger. 

The Minneapolis Heart Institute Foundation (MHIF) is an international leader in CTO-PCI research. Dr. Brilakis serves as the principal investigator of MHIF’s PROGRESS-CTO: Prospective Global Registry for the Study of Chronic Total Occlusion Intervention, which is the largest registry to date of international patients undergoing PCI for CTO blockages. As published in April 2018 in the Journal of American College of Cardiology: Cardiovascular Interventions, study results have shown that with improved equipment and techniques, percutaneous coronary intervention for chronic total occlusions is now being performed with remarkable success and low complication rates, especially over the last five years.

In 2018, MHIF launched the Complex Coronary Artery Disease Science Center with Dr. Brilakis as director. This innovative center aims to continue making the impossible possible through innovative research and education around treatment approaches for the most complex of coronary artery disease cases.

Roger is thrilled to represent a complex coronary artery disease success story. “Dr. Brilakis told me I had a challenging problem, but he never once gave me any indication that it was impossible,” said Roger. “I knew he was superbly trained in this sort of a situation, and he basically kind of inspired me from the moment I first talked to him. And the outcome of that surgery has been indicative of that feeling.”

Seven weeks after surgery, Roger was happy to resume his normal activities with no limitations. Three months later, he was once again enjoying shoveling his large deck. 

“I love it when it snows. We live way out in the woods, so it’s very beautiful,” said Roger. “I had no problem doing the shoveling, even though it was 27 degrees and windy. Last winter I had problems; the cold would cause pain in my chest when I went outside. This time I have no problems at all.” 

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