Complex coronary artery disease is a loosely defined term that describes a coronary artery disease (CAD) patient with a higher risk profile. In many cases, special care and treatment is necessary for these patients. Typically, patients who have CAD in addition to one or more of the following risk factors would fit this description:  
  • Diabetes
  • Chronic kidney disease
  • Increased age
  • COPD
  • Peripheral vascular disease
  • Calcium build up and thickening in the vessels
  • Unable to tolerate coronary artery bypass graft (CABG)

CMC’s New England Heart & Vascular Institute offers highly specialized treatments for these patients including atherectomy, left ventricular assisted atherectomy, left ventricular assisted percutaneous coronary intervention (PCI) and intravascular lithotripsy (Shockwave IVL).  Learn more: Shockwave IVL Hailed as Game Changer

Diagnosis, Treatment & Technologies

Chronic Total Occlusion Percutaneous Coronary Intervention (CTO PCI)

A percutaneous coronary intervention for chronic total occlusion (CTO PCI) treats patients who have a 100% blockage in one of their coronary arteries. This severe plaque buildup occurs over time in a condition called atherosclerosis. About 10-15% of patients with coronary artery blockages have 100% blocked arteries. CTO PCI is a complex procedure that is performed by only 1-2% of interventional cardiologists in the US.  Often patients are advised to undergo open heart bypass surgery or are treated with medications alone. Left untreated, the blockage may cause significant chest discomfort, shortness of breath, lower quality of life, and potentially decrease heart function.

CTO PCI is a complex procedure that utilizes similar catheters through the wrist or groin artery.  It differs from routine PCI in that, often, two catheters are placed in two different locations.  In addition, specialized equipment is used to get through, or around your body’s small bypasses to get the blockage open. This procedure take an average of three-four hours and patients are typically monitored overnight in the hospital. 

CTO PCI is an evolving field within Interventional Cardiology. In the United States, only a small number of centers have teams trained to perform the full spectrum of techniques to maximize success rate. The Interventional Cardiology team at CMC’s New England Heart & Vascular Institute is pleased to offer this option to patients with coronary artery disease.


An atherectomy is a procedure used to remove plaque from a coronary artery. It is a minimally invasive approach that uses a catheter inserted into one of the blood vessels. The catheter is fed to the heart and once it reaches the area of plaque blockage, a small laser or a tiny blade is used to cut away the plaque. This technique may be followed by an angioplasty or stent.  Typically patients will be kept overnight and may return home the following day.

Shockwave IVL

A new treatment in coronary artery disease – Shockwave IVL. Complex calcium can be challenging when trying to treat coronary artery disease (CAD).  The presence of calcium increases the complexity of CAD and the effectiveness of treatment. The technology of lithotripsy—using shockwaves or lasers to break up hardened masses in the body—has been used effectively for more than 30 years to treat kidney and gall stones. This same approach can be used to treat complex calcium in the coronary arteries. CMC is proud to be named one of three sites in the Northeast—and the only one north of Boston—to provide a new technology called the Shockwave Coronary IVL System. Shockwave IVL is an energy-based catheter which creates sonic pressure waves that travel through soft tissue, safely cracking calcium in the diseased artery. This technology represents a major advance in the treatment of CAD. 

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LVAD High Risk Atherectomy

In this type of atherectomy, a left ventricular assist device (LVAD) is used. This allows greater cardiac output for those with a weaker heart and helps the heart pump blood better.  It is typically used in high risk cases to provide enough time for the procedure to be completed. 

LVAD High Risk PCI

When the heart needs additional support during angioplasty or stenting, a left ventricular assist device (LVAD) may also be used. This pump increases the heart’s ability to move blood. 


coronary artery disease game changer


It’s called a breakthrough technology for treating advanced coronary artery disease and CMC was one of the first in the country to use it. Learn more about our physicians who are trained in this new technology and how the Shockwave IVL System uses sonic pressure to break up calcified plaque inside the arteries.

Cardiothoracic Surgeons & Interventional Cardiologists

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You have access to the most advanced cardiovascular and thoracic care in northern New England at CMC’s New England Heart & Vascular Institute. 

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