CHIP for complex blocks

In the field of interventional cardiology, some patients present with complex blockages in their coronary arteries that pose unique challenges for treatment. These complex, calcified, and chronic total occlusion (CTO) lesions have traditionally been considered difficult to manage. However, a relatively new approach called Chronic Total Occlusion Intervention (CTO-PCI) or CHIP (Complex High-Risk Indicated Procedures) has emerged as an effective solution for addressing these complex blockages. In this blog post, we will explore the concept of CHIP and its significance in the management of complex blockages in cardiology.

Understanding CHIP:

CHIP, or Complex High-Risk Indicated Procedures, refers to a specialized interventional cardiology approach designed to tackle complex coronary blockages, particularly chronic total occlusions (CTOs). CTOs are complete blockages that have been present in the coronary artery for an extended period, making them particularly challenging to treat using traditional angioplasty techniques.

The CHIP approach involves a comprehensive, multidisciplinary team consisting of interventional cardiologists, imaging specialists, and support staff. These highly skilled professionals collaborate to devise innovative strategies and utilize advanced tools and techniques to achieve successful recanalization of the blocked artery.

Key Aspects of CHIP:

  • Skill and Expertise: Performing CHIP procedures requires a high level of skill and expertise from interventional cardiologists. These specialists undergo extensive training and gain experience in handling complex lesions, understanding the anatomy of the coronary arteries, and utilizing advanced equipment and imaging modalities.
  • Imaging Techniques: Sophisticated imaging techniques such as intravascular ultrasound (IVUS), optical coherence tomography (OCT), and coronary computed tomography angiography (CCTA) play a crucial role in guiding CHIP procedures. These imaging modalities provide detailed information about the location, extent, and composition of the blockage, helping cardiologists plan and execute the intervention with precision.
  • Advanced Tools and Techniques: Interventional cardiologists performing CHIP procedures rely on an array of specialized tools and techniques to overcome complex blockages. These may include specialty wires, microcatheters, guidewires, crossing devices, and various angioplasty balloons and stents. Additionally, advanced techniques such as retrograde approaches, dissection re-entry, and subintimal tracking and re-entry (STAR) are employed to navigate and treat challenging lesions.

Benefits of CHIP:

  • Improved Procedural Success: CHIP procedures have shown significantly higher success rates in treating complex blockages compared to traditional techniques. The use of advanced tools, imaging guidance, and the expertise of the CHIP team contribute to successful recanalization of the occluded vessel, restoring blood flow to the heart.
  • Enhanced Patient Outcomes: By effectively treating complex blockages, CHIP procedures can improve patient outcomes, relieve symptoms, and reduce the need for further interventions. Restoring blood flow to the affected area of the heart can alleviate chest pain, improve heart function, and enhance overall quality of life.
  • Avoidance of Surgical Intervention: In many cases, CHIP procedures provide a less invasive alternative to open-heart surgery for patients with complex blockages. By successfully treating the blockages through minimally invasive techniques, patients can avoid the risks and lengthy recovery associated with surgical interventions.
  • Cost-Effectiveness: Despite being sophisticated procedures, CHIP interventions have demonstrated cost-effectiveness compared to surgical options. Shorter hospital stays, fewer complications, and quicker recovery times contribute to reduced healthcare costs and overall economic burden.

Considerations and Limitations:

While CHIP procedures offer significant advantages, it is important to note that not all patients or lesions are suitable for this approach. The decision to pursue CHIP depends on various factors, including the patient’s overall health, lesion characteristics, vessel size, and the experience and capabilities of the CHIP team.


Complex blockages in the coronary arteries have long presented challenges in interventional cardiology. However, with the emergence of CHIP procedures, there is renewed hope for patients with complex lesions, particularly chronic total occlusions. By combining advanced imaging techniques, specialized tools, and a multidisciplinary approach, interventional cardiologists can achieve successful recanalization, improve patient outcomes, and offer an effective alternative to surgical interventions. As technology and expertise continue to advance, the future holds even greater possibilities for managing complex blockages and improving the lives of patients with challenging cardiovascular conditions.