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Dennis Polega: Chronic Coronary Total Occlusion (CTO)

Dennis Polega - Chronic Coronary Total Occlusion Patient Story

The Challenge: Chest Pain

For years, Dennis Polega had been having chest pain that came and went. Numerous cardiac stress tests showed no blockages in his heart arteries. Eventually, he was diagnosed with acid reflux — heartburn.

The heartburn medication did not always work, and sometimes the chest pain would return.

Although he didn't realize it at the time, Dennis was becoming gradually less able to take part in many of the everyday things he used to.

"What a humbling experience it is," he says, "when your wife has to go out to shovel the snow."

In January 2014, Dennis's youngest daughter, Deidra Kacvinsky, and his wife left for a prenatal ultrasound test while he stayed behind to help with a remodeling project on his daughter's new home.


As he worked, he began to experience shortness of breath, nausea, and fatigue. Believing he was having a mild heart attack, Dennis once again went to the hospital and a stress test revealed that his right coronary artery was completely blocked.

The Path to UPMC: Seeking a Second Opinion

Dennis had what doctors call chronic coronary total occlusion, or CTO. CTO means that a heart artery has been completely blocked for more than three months.

Most blockages to heart arteries are caused by plaque, which is partly made up of fat and calcium.

Because the plaque involved in CTO contains a great deal of calcium, it can be very hard, making it difficult to perform angioplasty. This is one reason why many cardiologists recommend bypass surgery for people with CTO.

Small blood vessels had grown between one of Dennis's unblocked coronary arteries and the blocked one. Because his body had partially adapted, the doctors recommended treatment with five medications instead of bypass surgery.

Dennis had accepted his condition. His daughter, however — a lab technician who works for UPMC — kept urging him to seek another opinion.

He finally gave in and made an appointment at the UPMC Heart and Vascular Institute.

The Solution: The Hybrid Approach to Angioplasty and Stenting

Catalin Toma, MD, and Conrad Smith, MD, interventional cardiologists with expertise in treating CTOs, work together in a procedure that is called the hybrid approach because of the numerous methods they use to gain access to the plaque.

Few centers in western Pennsylvania have the skill and expertise necessary to offer this procedure.

Dennis underwent the hybrid angioplasty procedure and after "half an hour it felt like somebody took 10 pounds off my chest," he says. Dennis was out of the hospital after a weekend.

Now fully recovered, Dennis reports that he's back to performing all activities he couldn't before — things we take for granted — like shoveling snow.

Dennis' treatment and results may not be representative of similar cases.

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