In April, Rajesh Sachdeva, MD, Bradley Hughes, MD and Barry F. Uretsky, MD wrote that the retrograde technique has developed into a viable option, as the process continues to evolve, naming their article, in part "The Tale of a Long and Winding Wire." They add, "the retrograde approach for CTO is a relatively new treatment strategy with its attendant complications having not yet been fully appreciated and described."
Karmpaliotis acknowledges that there are skeptics because of the procedure complexities. But he is a firm believer in the procedure as taking on a more important role in the future across the country.
“There has been a lot of scrutiny not just by our peers; (but) the complication rates have been extremely low, almost better than regular angioplasty,” Karmpaliotis says, referring to work at Piedmont.
“For patients with complex CTOs, traditional angioplasty may not be an option, open heart surgery may be risky or undesirable and the medications used for the relief of symptoms may cause side effects,” Karmaliotis says.
“There are hundreds of thousands of patients who had bypass surgery in the past 15 or 20 years,” Karmpaliotis says. “So now we are faced with a problem, patients who had bypass surgery 15 years ago have bypass grafts that are not functioning anymore.They are blocked.”
William D. Knopf, MD, COO at Piedmont Heart Institute and vice president of Cardiovascular Services at Piedmont Hospital, in an interview, praised the “skill set and judgment and passion that Dimitri has.”
“The complexity and time it takes for the procedure is not for the faint of heart,” Knopf says.
Karmapliotis leads a team of specialists who concentrate on the antegrade or retrograde angioplasty. According to Knopf, the hospital hopes to “double our volume in the next six months by adopting the latest technologies and continuing to work with world-renowned specialists in the field.”
Working with other experts around the nation, particularly William Lombardi, MD, based in Bellingham, WA, has been invaluable, says Karmapliotis.
“What he taught us—it wouldn’t have been possible without his leadership,” he says.
“I am convinced there are a lot of opportunities to help people, and there are endless possibilities what we can do with this,” Karmapliotis says.