Jonathon Niemczak recalls his first heart ailment 20 years ago when he was rushed to the University of Michigan emergency room after passing out at home.

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The patient, then 54, was diagnosed by U-M Frankel Cardiovascular Center cardiologist Kim Eagle, M.D., with a blockage in his arteries. He underwent a repair procedure known as stenting to correct the problem.

But this wouldn't be the last of Niemczak's heart issues, which have spanned two decades and have since included quadruple bypass surgery and a heart attack in 2015 when tests revealed only one functioning bypass.

That's when Frankel CVC interventional cardiologist Daniel Menees, M.D., was brought in to perform a minimally invasive procedure to reopen Niemczak's completely blocked artery, a condition known as a chronic total occlusion (CTO).

What is a CTO?

A CTO is caused by atherosclerosis, which is a buildup of plaque or fatty deposits within the arteries. Atherosclerosis causes the artery or arteries that supply blood to the heart to become blocked.

As the blockage worsens, symptoms typically develop. When the blockage completely fills the artery (100 percent blockage), it is called a CTO.

Symptoms of CTO may include:

• Pain, pressure or tightness in the chest

• Shortness of breath

• Dizziness

• Fatigue

• Nausea

• Pain in the upper body and arm

• Rapid or irregular heartbeat

"Patients typically develop symptoms when an artery becomes narrowed by a blockage of 70 percent or more," says Menees. "Most times, these can be treated relatively easily with stents. However, with a CTO, the artery is 100 percent blocked and so placing a stent can be quite challenging."

Adds Menees: "The body often adapts to the complete blockage, allowing the heart to compensate by creating 'natural' bypasses or collateral blood vessels around the blockage. While this minimizes any damage to the heart that might result because of the blockage, the collateral blood flow may not be enough to limit symptoms."

Specialized treatment for CTO

While traditional treatment for CTO has primarily been coronary artery bypass grafting performed during open-heart surgery, newer techniques and advanced technologies have enabled Frankel CVC doctors to offer minimally invasive alternatives.

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One such method — a CTO percutaneous coronary intervention (PCI) — was used to successfully restore Niemczak's blood flow.

The procedure is performed by experienced interventional cardiologists with specialized training in advanced methods to treat CTO without open-heart surgery.

During PCI, advanced wires and specialty catheters are used to tunnel through the complete blockage. The procedure, Menees says, often requires "creative paths" to get through the blockage.

These routes, he says, include "using the wall of the artery to go around the blockage or using the newly created collateral vessels to approach the blockage from the backside."

Then, using a technique called angioplasty, a small balloon is passed into the blockage and inflated to effectively push the blockage to the side. This approach, followed by stenting, creates a wider opening in the arteries to restore normal blood flow.

Progress at home

Niemczak, a retired electrical engineer, says he's feeling great since the procedure.

Through rehab sessions that followed at the U-M Rehabilitation Center, the 74-year-old has gained a new appreciation for the benefits of regular exercise. He's also become an avid yoga practitioner, taking classes at the rehab center to improve his balance and flexibility.

"It's not a requirement, but I've learned that exercise is good," Niemczak says, noting that the new way of life has boosted his endurance and overall health.