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Complex and High-Risk Interventional Procedures (CHIP)

If you’ve been turned down for traditional coronary artery disease treatments, your provider may refer you for CHIP.
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For many patients with complex coronary artery disease (CAD), surgery is not an option because of their coexisting medical conditions or increased risk of complications.  

That's why experts at University of Iowa Heart and Vascular Center are dedicated to providing the most advanced treatment options for high-risk patients with complex CAD. 

Our interventional cardiologists specialize in complex and high-risk interventional procedures (CHIP) to treat the most difficult cases of CAD. This includes chronic total occlusion (CTO), which is a complete or nearly complete blockage of one or more coronary arteries. 

CHIP procedures are performed in our state-of-the-art cardiac catheterization lab. Our lab uses the latest technologies to provide minimally invasive surgical interventions and improve outcomes to help you get back to your life faster.  

Team-based approach to CHIP

UI Heart and Vascular Center experts are the most experienced in Iowa for treating patients with complex CAD.  

Patients meet with our cardiologists, interventional cardiologists, and cardiac surgeons to determine the best treatment option for every individual. Together, our comprehensive heart team creates a personalized treatment and recovery plan that is designed to meet your individual needs.

This team includes:

  • Interventional cardiologists 

  • Cardiac surgeons 

  • Heart failure cardiologists 

  • Cardiac anesthesiologists 

  • Cardiac electrophysiologists 

  • Cardiac catheterization lab nurses and staff 

  • Intensive Care Unit (ICU) nurses 

  • Mechanical circulatory device specialists 

Techniques used during CHIP

CHIP requires specialized skills, training, and equipment. There are a variety of techniques and approaches used during CHIP, including: 

  • Diagnostic cardiac catheterization to help identify blockages  

  • Angiograms and echocardiograms to see your blood vessels and heart 

  • Intravascular ultrasound to produce images of the artery walls  

  • Laser and rotational atherectomy to remove plaque from the blood vessels, especially calcified plaque 

  • Specialized support devices to increase the safety and success rates of high-risk procedures 

  • Special guide wires, balloons, and catheters that help reopen completely blocked arteries.  

Because CHIP is most often used for patients who have already been diagnosed with high-risk CAD, heart failure, or severe heart valve disease, catheter-based devices such as ventricular assist devices (VAD) may be used during CHIP to help support the heart and blood flow.  

Minimally invasive option for chronic total occlusion

Specialists at UI Heart and Vascular Center offer a highly advanced approach to treating patients with CTO, called chronic total occlusion percutaneous coronary intervention (CTO PCI). CTO PCI is a minimally invasive technique to treat patients with complete or nearly completely blocked coronary arteries. Historically, the only option to help these patients was coronary artery bypass grafting (CABG) or open-heart surgery. CTO PCI provides a new option for patients who do not qualify for surgery.  

Who may benefit from CHIP?

CHIP procedures are a great alternative for patients who have been turned down for traditional treatments for CAD due to the complexity or severity of their disease, anatomy, or comorbidities.  

Factors that could make you a high-risk candidate for CHIP include: 

  • Advanced age 

  • Advanced heart failure 

  • A history of diseases such as diabetes, kidney disease, or stroke 

  • Previous open-heart surgery 

  • Complex heart artery anatomy 

  • Previous unsuccessful coronary artery procedure 

  • Chronic total occlusion (CTO) 

Sidebar content
  • Heart and Vascular Services
    • Cardiac Imaging
      • Coronary Calcium Scan (Calcium Score test)
    • Cardiac Rehabilitation
    • Cardiology
      • Angina
      • Aortic Aneurysm
      • Atherosclerosis
      • Coronary artery disease
      • Echocardiogram
      • Hypertrophic Cardiomyopathy (HCM)
      • Pulmonary Hypertension
    • Cardio-Oncology
    • Cardiovascular Genetics
    • Cardiac Electrophysiology
      • Atrial Fibrillation
      • Atrial Flutter
      • Cardiac Ablation
      • Cardioneuroablation
      • Convergent Procedure
      • Heart Palpitations
      • Lead Extraction
      • Pacemaker
      • Implantable Cardioverter Defibrillator (ICD)
      • Remedē® System
      • Tachycardia
    • Heart Failure
      • Cardiac Amyloidosis
      • CardioMEMS™ Heart Failure System
      • Sarcoidosis
    • Heart Surgery
      • Aortic Valve Surgery
      • Heart Transplant
      • ECMO: Heart and Lung Life Support
        • A Family Guide to ECMO
        • Criteria for ECMO
        • ECMO Training Course
        • Immediately Contact the ECMO Team
        • The Iowa Difference for ECLS Care
        • Welcome from the ECMO Director
      • Left ventricular assist device (LVAD)
    • Interventional Cardiology
      • Atherectomy
      • Complex and High Risk Interventional Procedures (CHIP)
      • Percutaneous Coronary Intervention (Angioplasty)
      • Percutaneous Ventricular Assist Device (Impella)
    • Structural heart and heart valve disease
      • Atrial Septal Defect (ASD)
      • Left Atrial Appendage Closure (Watchman Device)
      • Paravalvular Leak (PVL) Closure
      • Patent Foramen Ovale (PFO)
      • Transcatheter Aortic Valve Replacement (TAVR)
      • Transcatheter Mitral Valve Repair (MitraClip)
      • Tricuspid Valve Repair and Replacement
    • Vascular Surgery
      • Deep vein thrombosis
      • Peripheral Artery Disease
      • Thoracic Outlet Syndrome (TOS)
      • Varicose Veins and Spider Veins
Get a second opinion on your chronic total occlusion

If you’ve been diagnosed with CTO and your provider told you it’s not treatable, request a second opinion with the UI Heart and Vascular Center. 

Our interventional cardiologists are among a select few specialists in Iowa trained to treat CTO patients who are not eligible for traditional surgery. Thanks to our expertise in this new, minimally invasive approach, we’ve successfully treated many people who thought they were out of options. 

Our Care Team

UI Health Care CHIP specialists perform the largest volume of minimally invasive procedures in the state.
Jason Allen, MD portrait

Jason
Allen
MD

  • Heart and Vascular
4.93 out of 5 (367 ratings)
Ahmad Arham, MD portrait

Ahmad
Arham
MD

  • Heart and Vascular
Phillip Horwitz, MD portrait

Phillip
Horwitz
MD

  • Heart and Vascular
4.80 out of 5 (869 ratings)
Hossein Ouranos, MD, MS portrait

Hossein
Ouranos
MD, MS

  • Heart and Vascular
James Rossen, MD portrait

James
Rossen
MD

  • Heart and Vascular
4.61 out of 5 (682 ratings)
Vikram Sharma, MBBS portrait

Vikram
Sharma
MBBS

  • Heart and Vascular
Nicholas E. Walker, MD portrait

Nicholas E.
Walker
MD

  • Heart and Vascular
4.84 out of 5 (2,376 ratings)

Not sure whether CHIP are right for you?

If your doctor has referred you for an interventional cardiology consultation, we'll connect you with an expert in the field.
Call 1-319-356-7102 Request an appointment Refer a patient

Locations and Offices

Heart and Vascular Center (4 JPP)
4800 John Pappajohn Pavilion (JPP)
Level 4, Elevator I
1-319-356-7102
Clinic
UI Heart and Vascular Center Interior location image at UI Hospitals & Clinics
In Medical Center University
200 Hawkins Drive, Iowa City, IA 52242

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Chronic total occlusion FAQs
November 6, 2023

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Awards and Recognition

A Gold Level ECMO Center of Excellence
The Extracorporeal Life Support Organization (ELSO) has named the UI Health Care Heart and Vascular Center an ECMO Center of Excellence with Gold Level standing. The award recognizes excellence and exceptional care.
Joint Commission Gold Seal Graphic
Joint Commission Gold Seal of Approval
Our LVAD program has earned the Joint Commission's Gold Seal of Approval. This means that we meet rigorous performance standards and deliver high-quality, safe care.
Wellmark Blue Cross Blue Distinction® Center+ designation
Expertise in cardiac care has earned UI Health Care the Wellmark Blue Cross Blue Distinction® Center+ designation. This means we’re a center of excellence that delivers high-quality, specialized care and better results.
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