News Desk, News Nation 360 : A 59-year-old male patient underwent an extremely difficult CTO-angioplasty with IVUS guidance at Manipal Hospital, Broadway, under the supervision of Dr Norihiro Kobayashi, a renowned Interventional Cardiologist from Yokohama City Hospital in Japan. The patient was admitted to Dr Arijit Ghosh, HOD - Interventional Cardiologist, Manipal Hospital, Broadway, with complaints of chest pain with exertion. Coronary angiography indicated a significant obstruction in the left coronary artery and a complete blockage in the right coronary artery, often known as Chronic Total Occlusion (CTO). Chronic Total Occlusions (CTOs) develop gradually and are dense, calcified blockages in coronary arteries that have traditionally required bypass surgery for management. Advances in interventional cardiology now allow many CTOs to be treated with minimally invasive percutaneous coronary intervention (PCI). Modern CTO angioplasty utilises specialised guidewires, catheters, micro-guidewires, and imaging technologies such as Intravascular Ultrasound (IVUS) to precisely navigate and open these hardened blockages. The technical challenge involves crossing the occluded segment using stiff, tapered, or hydrophilic-coated wires and, often, multiple catheters, followed by balloon angioplasty and stent placement to restore blood flow. IVUS provides detailed visualisation of the vessel’s interior, guiding wire placement and confirming

lesion clearance. At Manipal Hospital, Broadway, a team led by Dr Kobayashi (international proctor) and Dr Subhasis Roy Chowdhury (Cath Lab director) successfully performed a complex CTO PCI, reopening a totally blocked artery and enabling rapid patient recovery and next-day discharge—an advantage over conventional bypass surgery. Studies show that successful CTO PCI is associated with improved survival, fewer symptoms, and reduced need for subsequent bypass procedures, making it a preferred option for select patients. This approach is now considered for symptomatic patients who do not respond to medical therapy and have isolated CTOs, highlighting the importance of advanced hardware, precise imaging, and expert technique in contemporary cardiac care. Sharing his experience, Dr Subhasis Roy Chowdhury, Director – Cath Lab, Manipal Hospital, Broadway, stated that CTO interventions rank among the most advanced cardiac procedures performed in catheterisation labs around the world. The success of this instance demonstrates how cutting-edge technology and skilled collaboration can alter the course of therapy for individuals who might otherwise require open-heart surgery. With IVUS-guided and sophisticated wires, they were able to explore and open arteries that were previously thought to be impenetrable by angioplasty.

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