When patients experience angina-type chest symptoms but are not found to have blockages by an angiogram, they might have vasospasm. Unlike blockages from atherosclerotic plaque, angina from vasospasm usually do not occur during exercise but occur sporadically at rest, often at night or in the early morning hours. To test for this, we inject acetylcholine into coronary arteries. Normal arteries relax and dilate with acetylcholine, but patients with vasospasm will develop intense constriction of coronary arteries, thereby restricting blood flow and causing angina.

Normal coronary arteries run along the outside of the beating heart, but many patients are born with bands of muscle that wrap around the coronary arteries and can choke the vessel enough to block blood flow and cause angina. This is called myocardial bridging (MB) and for many years has been dismissed as a cause for angina. But we now know that MB is one of the causes of angina with non-obstructive coronary arteries (ANOCA) and should be evaluated thoroughly when suspected. We offer detailed MB assessment using cardiac CT scanning, intracoronary imaging, and stress testing.

Performed with current state-of-the art techniques such as frequent use of intravascular imaging, to achieve optimum results by imaging from within the coronary artery to achieve the best possible stent results and durability. Examples include ultrasound (IVUS) and optical coherence tomography (OCT).

Providence Heart Institute Interventional Cardiologists have extensive experience in so-called “CHIP” cases (Complex, High-risk, Indicated Procedures), for patients with especially difficult coronary blockages as well as medical conditions which make fixing their coronary arteries very challenging and risky.

We regularly see patients for second opinions or for repeat procedures; often our patients have been told elsewhere that there are no options. We understand the importance of feeling better and being able to do more in your lives, so we review each case as a team of doctors to determine whether there is a feasible and reasonably safe option for stents.

We have the full range of devices including coronary drills, lasers, and sonic shockwaves, to tackle the most difficult blockages; and for patients who might become hemodynamically unstable during such procedures, we have a variety of temporary heart pumps such as Impella, Tandem Heart, and extracorporeal membrane oxygenation (ECMO) to ensure patients remain stable while we focus on doing the best job we can to fix their coronary blockages.

Unlike partial coronary blockages, complete coronary blockages (i.e. CTOs) are much more difficult to open and stent. Fixing CTOs requires the most advanced interventional cardiology techniques and technology. We have a dedicated CTO program with specialized cardiologists who are experienced in these most advanced techniques and technology. We are one of the highest volume CTO centers in the Pacific Northwest with success rates and safety records comparable to the best CTO programs in the country.

Severe coronary blockages are not always found in patients with suspicious chest symptoms. Problems with the much smaller downstream coronary arteries, known as microvascular dysfunction (CMD), can also be the cause. This is especially true in middle-age women amongst whom nearly 25% have CMD. This can be difficult to diagnose but doing so can help direct therapy as well as bring clarity to a patient’s symptoms. We have specialized technology to help determine whether CMD might the cause of your symptoms.