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Treatment Program

Complex Coronary Heart Disease

Our multidisciplinary team provides treatment for the most complex forms of coronary artery disease, including high-risk patients being treated for other chronic conditions. 

heart providers in operating room

About complex coronary artery disease

Mass General Brigham Cardiovascular provides the most advanced care for complex coronary artery disease, including patients with underlying conditions like diabetes, metabolic syndrome, renal insufficiency (kidney failure), and lung disease. 

Our multi-disciplinary team of cardiologists and cardiac surgeons offer comprehensive inpatient and outpatient clinical services. We develop in-depth treatment plans tailored for each patient’s condition, age, symptoms and risk factors, drawing upon diagnostic tests and procedures to determine the best line of treatment. We offer the latest cutting-edge treatments, from innovative diagnostics to state-of-the-art medical, interventional, and surgical therapies, as well as clinical trials.  


Understanding Coronary Artery Disease and Prevention Options

Marc Sabatine, MD, MPH, Cardiologist and Chair of the TIMI Study Group at Brigham and Women's Hospital, explains what coronary artery disease is and how people can help control their symptoms.

Complex coronary artery disease conditions we treat

Tara’s Story: Finding a New Purpose After SCAD

Tara Benoit was an active, healthy mother of two boys when sudden chest pains changed her life forever. Despite being in excellent physical condition, she was diagnosed with a spontaneous coronary artery dissection, or SCAD, a rare condition where the coronary artery tears without warning. She received care at the Corrigan Women’s Heart Health Program at Massachusetts General Hospital, one of the few centers in the country that specializes in treating SCAD.

Tara and her two sons go for a bike ride on a sunny day in a park with trees lining the pathway

Complex coronary artery disease symptoms

Symptoms may include:

Diagnosis of complex coronary artery disease

Complex coronary artery disease is diagnosed through advanced imaging techniques by dedicated cardiac imaging specialists. Tests used in diagnosis may include:

A cardiac catheterization is used to evaluate many heart diseases, including coronary artery disease. During the procedure, a small hollow tube, known as a catheter, is put into a patient’s body via a blood vessel in the groin or arm and guided through the aorta into the heart. Once the catheter is in place, several diagnostic techniques may be used, including an angiogram.

During an angiogram, a special dye is injected into the blood vessels of a patient’s heart, via the catheter. This dye allows an X-ray machine to visualize the flow of blood through the heart muscle, helping doctors to determine the location and severity of any occlusions (blockages) in the blood vessels.

Cardiac computed tomography (CT) is a non-invasive test used to evaluate various parts of the heart. During the scan, an X-ray machine rotates around a patient’s body while they lie on a table. 

Small patches are placed on the patient’s chest, arms, and legs to monitor the electrical activity of the heart. An electrocardiogram shows how fast the heart is beating, the rhythm of the heart beats, and the timing of electrical impulses as they move through the different parts of the heart.

High frequency sound waves are used to create a clear image of the heart, allowing a doctor to monitor the patient’s heart structure and function. There are several types of echocardiograms that can be used to assess various aspects of the heart, including the flow of blood, the function and position of different heart structures, the overall size and health of the heart and major blood vessels, and the thickness of heart walls. Echocardiograms may be performed in conjunction with other tests, such as exercise stress tests.

During an exercise stress test, a patient exercises on either a treadmill or a stationary bike to raise their heart rate and blood pressure. The exercise intensity gradually increases until the patient becomes fatigued. Blood pressure, breathing, and heart rate are monitored throughout the test, with oxygen saturation monitored in some cases. If a patient cannot perform the test physically, medications can be used to simulate exercise.

Following a cardiac stress test either from exercise or induced via medication, your doctor will use nuclear medicine imaging to observe your heart. These tests can provide information about blood flow to the heart muscle at rest and during stress, any previous damage to the heart muscle (e.g. from a previous heart attack), and the heart’s ability to pump blood. The type of test used depends on your medical history, current condition(s), and overall health.

Approach to treatment for complex coronary artery disease 

Our specialists offer pioneering treatments for patients with the most serious forms of coronary artery disease, who have often been turned down for bypass surgery, turned down for stenting, or told there were no options to treat their coronary blockages. Our physicians develop the latest treatments and therapies for coronary artery disease. Depending on the diagnosis, medical interventions or surgical procedures may be suggested. 

  • Coronary artery disease prevention, including lifestyle changes like diet and exercise
  • Medications to control symptoms, including statins, beta-blockers, and ACE inhibitors

  • Minimally invasive techniques, such as coronary angioplasty, key-hole surgery, and robotic surgery
  • High-risk coronary artery interventions
  • Percutaneous coronary intervention (PCI)
  • Chronic total occlusion PCI (CTO PCI)
  • Off-pump (beating heart) bypass procedures
  • Beating heart surgery
  • Bypass surgery
  • Brachytherapy
  • Contrast sparing options
  • Radiation sparing options

CTO PCI is a procedure performed by experienced cardiac interventionalists with specialized training in advanced methods to treat CTO blockages. Only 1-2% of cardiac interventionalists in the U.S. can perform the full range of CTO PCI. Mass General Brigham is one of the few centers in the U.S. to use a combination of antegrade (forward-moving, including dissection/re-entry) and retrograde (backward-moving) approaches to access blockages.

When a blockage occurs, new blood vessels known as collateral blood vessels are formed around the blockage to help with blood flow. Using advanced guide wires, our surgeons insert a catheter into these collateral vessels, entering the blocked artery from multiple sides. Using a technique called balloon angioplasty, a small uninflated balloon is placed at the tip of the catheter and inflated while in the artery. This approach, along with stents, is used to create a wider opening in the arteries to restore blood flow. The procedures vary in duration from 2 to 5 hours, depending on the complexity of the blockages. All patients are admitted to the hospital overnight after the procedure in order to be monitored.

During a complete arterial revascularization (also known as total arterial revascularization), a surgeon harvests an artery from elsewhere in your body, usually from your arm or your chest, and uses it as a graft to connect your aorta to your coronary arteries. This procedure restores blood flow to the heart muscle and is an option for patients who may not be good candidates for bypass surgery. Arterial revascularization may lead to more durable results than venous grafts, as the stronger walls of the arteries are better able to withstand the blood flow coming from the aorta. This approach is therefore most valuable in younger patients.

As complete arterial revascularization is a form of open-heart surgery, your care team will monitor you carefully in the hospital to ensure no postoperative complications have occurred: full recovery may take several months. 

Coronary artery disease research and clinical innovation

Physicians at Mass General Brigham Heart have revolutionized medical care for coronary artery disease. Whether it’s inventing a new imaging modality to visualize and evaluate parts of the heart or conducting clinical trials for innovative procedures and interventions, we are at the forefront of the latest discoveries, bringing clinical breakthroughs directly to our cardiology patients.

Learn how our experts are advancing complex coronary artery disease interventions and researching why women are more likely than men to decline statin therapy

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