 Hello, I'm Dr. Nahas, Interventional Cardiologist. Today, I want to talk to everyone about a special condition that we face in Interventional Cardiology. It's called the chronic total occlusion. This is when the vessel is closed 100% and becomes very hard to fix. And with us today, we have Mr. Sharpe, who is one of my patients who actually has experienced the same problem. And I worked on him and he wants to tell everyone about his personal experience so other patients may learn from it. So, hello Mr. Sharpe. Good morning, Doctor. Good morning. How old are you? I'm 71. Bless you, you look good. Thank you. You look good right now. Thank you. Yes, good, good. So, tell me about your personal life. Where do you live? I live in Dearborn Heights, Michigan. And, you know, I'm retired now, six years. And, you know, life was fine as a retiree until about 69 years old in which I found out that I did have a, you know, a bad heart. I had plug darteries. Yes. And at the age of 69, in 2019, I had a heart attack. And I had a stent that revived me. Okay. Followed by, two months later, by bypass surgery. Mm-hmm, yes. Followed by about three to six months rehab. That was pretty, it was pretty intense recovery for me. Yes. And then everything was fine for about a year. I noticed it about April of 2021. My breathing became slow. I was huffing and puffing a bit. Mm-hmm. And by the way, shortness of breath is another common symptom of blockages in the heart. Not just chest pain. People think heart disease only cause chest pain, which is not the case. A lot of people experience other symptoms like fatigue and shortness of breath. The walking distance may get shorter because they feel tired. So Mr. Sharp is probably one of those people. Go ahead. Yes. I had no chest pain. So I wasn't experiencing that. So I found myself going to the hospital with the shortness of breath. Yes. Not being able to catch my breath. Uh-huh. I had kind of a chronic cough at the time. And I happened to run into my cardiologist at the hospital. Yes. Who, he was working that day. Dr. Soben, he ordered me to go to the cath lab immediately to see what was going on because he was concerned. Yes. So I went there and he found that the bypass that I had was, had failed. And that I was, you know, to prepare myself for a couple stents in a couple days. Yes. Um, in a couple days, um, probably about four days later, he did the, uh, the catheterization and did a stent, but he wasn't able to do one stent because of 100% blockage. He said he could not penetrate the blockage. So Mr. Sharp, um, was referred to me by Dr. Sob, who is a local cardiologist, a great guy, and he opened one of his blockages that was not 100%, it's called the circumflex. There was the other one that was 100%, the one in the front, they called the widow maker. I hate that word, but it is used. And that was 100%. That's one doctor so called me to help out Mr. Sharp because those procedures are like niche procedures for certain cardiologists. Not everyone really does them. They are lengthy and are time consuming for the operator and for the patient. And, uh, so that's when I met you and then we talked about, uh, topium blockage and we talked about the risks and I told you that the risk is a little higher than average as you plastic, although still low risk is about 1 to 2%. And then from there we did the procedure. So now we did the procedure. Tell me about, if you remember anything from the procedure on the table, was there anything like bad or good or anything you want to say about it? I seem to remember the procedure quite well since I was definitely, I felt I was like in a paralyzed situation, but I was awake looking around the room, hearing the voices, listening to the conversation in no pain, but, uh, being curious as I was, I was trying to grasp as much as I could, I could pick up. Yes. And I didn't know how long I was in there and, you know, it felt like very short time. Yes. Uh, you know, at the recovery room I was probably recovered within 15 to 20 minutes. Yes. So you were about 2 hours in the procedure. Average angioplasty, if I want to open 90% blockage for example, most of those take about 15, 20 minutes. Some shorter, some not longer. When it comes to chronic total occlusions, the 100% that is old, then usually the time is a lot longer. Average is 2 to 3 hours. Yours was on the shorter one, shorter side one. So, um, so you recovered, you went home next day, correct? Yes. I was actually within an hour they had placed me in a hospital room. Um, within 2 hours I was totally bored and wanted to go home, but I couldn't. I had to lay still. Yes. Uh, contrary to the bypass, which was, I was 11 days without moving. Yes. Here within 1 hour I was recovered enough to walk around the room. I go to the restroom by myself, wasn't hooked up to any tubes or any medications or, and spent the day there and was discharged the next afternoon gladly. I went home, drove myself home. You don't like hospitals, do you? No I don't. It was not pleasant. Nobody does, yes. You know, as one of the orderlies told me, it was a, it's a great hospital, but a crummy hotel. Yes. And so I, I was glad to leave. I was glad to get the fresh air. I had to get away from, uh, you know, the plastics. And, uh, that day I felt good. Okay. I was always worried about, you know, they, cause, um, you had told me about the wounds to be gentle, no moving around, 3 or 4 days, no lifting. And then within a week I was, uh, fine. I was walking the stairs normally. No symptoms? No symptoms, no breathing problem, no chest pain, no groin pain, any pain. Wonderful. So I was like pain-free right away. Kind of amazed. Saw the cardi, my cardiologist, Dr. Sob. I saw you like probably about, um, 11 days later and, uh, and I told you at that time it wasn't, you were happy and I was happy. You know, it feels really good from a doctor's standpoint when I hear my patient is doing very well. When you put efforts into this procedure, it takes a lot of mental power to focus on it for two and a half hours, three hours, four hours sometimes. And you want to see the fruit of your labor maturing. And you want to make sure that the patient improved not just under one procedure and did not improve. Now the success rate with this procedure from the first attempt, Mr. Sharp, is about 80% in the experienced hands. Sometimes it doesn't work from the first attempt. We do it second time and the success rate goes up to over 90%. On the other hand, average angioplasty that is not 100%. The success is over 95%. So you know, we're not perfect in this procedure, but definitely better than not doing anything or just doing medications. Patient feel better usually right away, just like Mr. Sharp said. And unfortunately we have to go from both groins most of the time, because sometimes we have to go from the collateral or the back door, we call it. We go through the main vessel that we are unblocking. Sometimes we have to go backward from the other vessels that is giving it blood flow or quantum collateral. We go through microchannels with very tiny little wires and catheters to enhance the success rate from both ends of the blockage. We go from this end and this end to go through it. And this is the niche and the technique that we have developed about 10 years ago. And usually in every major hospital there is one operator who can do this. I happen to be the one here in Dearborn. And I'm glad to have done that. So I'm very happy for you that you're doing well. And I understand that you are about to start rehab. I have been rehabbing myself just because the weather is so pleasant that I've been walking gingerly through the hiking trails, walking in the evenings in the cool weather. I found myself at my first walk, which was probably two weeks after the procedure. I was just on a junior high hiking trail. And I did four laps, which was a mile and an eighth. And I was very happy that it was just, I found most of the problem was my legs were out of shape and I was out of condition, but I had no breathing problem, no chest pain. Wonderful. And the second time I was in the hospital where Dr. Soba diagnosed me, the heart surgeons came in and they wanted to do another bypass. And it just terrified me. And you know, Dr. Soba says we have an alternative that we have to do this first. And five years ago the alternative was not here. Maybe 10 years ago, you know. Everybody like you would have gone through a second bypass. Unfortunately, second bypass had more risk and longer recovery too. I have to say something about bypass. You know, it is still done in certain patients when we feel the success of angioplasty is low and the bypass success is higher. So still have role in our patient care. Yes. And it was more like my arteries and veins were the cause of the problem. So that I didn't, whatever reason that was that the arteries weren't taking. Well, not good enough, yes. Another option to open it with angioplasty and stenting and gives you a new page of your life. Yes. And at this age, you know, I'm not in mountain climbing. I'm walking gingerly, I'm breathing fresh air. I can sing and I can breathe. And you know, I'm not getting the shortness of breath and tiredness. In fact, I find if I nap at midday, I end up being awake at night. So I'm kind of even having to avoid napping in order to get a fuller night's sleep. I see. So that was one thing that kind of, I kind of enjoyed an afternoon nap, but now it was, if I took this nap, which was only 30 minutes to 40 minutes, it would shorten my nightly sleep and I find myself awake at five in the morning. You have too much energy now. I'm refreshed with, you know, six hours of sleep per day and without feeling exhausted, I feel good and refreshed. I'm keeping my weight down. Yes, you look good. And you're eating local strong diet. I'm on the, you know, the heart friendly diet. I'm trying to keep my weight up because I find myself just not with a hearty appetite. So I have to eat on a regular basis. So the best diet now, you're talking about diet, I'm glad you brought up. The best diet we recommend, actually, what is recommended by the American College of Cardiology, it's a Mediterranean diet, and you can look it up on internet. Okay. It has high vegetables and fruits, high contents of nuts and chicken and fish, less meat, less dairies. That's something we recommend to our patients who are cardiac patients. I love that diet. Yes. It is friendly. It's tasty, too. It is tasty. And I find myself like supplementing with nuts. I do have to grind them up a bit. Yeah, sure. Because I find them easier with my digestion, but the calorie content is so high. Yes. That it keeps me away from the, you know, even the chicken and the fish, which are nice, but... Yes. It has less carb, olive oil, maize, butter. The fish oils, the mega threes from the fish. Wonderful. It's nice. Wonderful. And I have a wife that takes care of the diet. She's kind of a strict vegetarian, but she likes her fish and chicken also. Yes. So she's on that same part of the diet. Also, support is very important. Yes. She likes hiking with me. She likes... She wants me to be youthful again. You are. And I feel better now. Wonderful. And I'm so... I'm grateful for that procedure. Wonderful. Because I did not feel this way. I was hoping to feel this way from the bypass, but it never happened. I was disappointed because everyone told me that from the bypass, you'll feel, you know, 10 years younger. And for me, it didn't happen. So, you know, I was glad to feel that way now. Well, I'm really thankful to you for sharing your information and experience with our patients. Yes. I think that will benefit a lot of people when they know there's other options available to them. And I want to thank you for your valuable time as well to come here and talk about it. My pleasure.