Innovative Coronary Procedure Helps Runner Achieve His Dream
In October 2016, 53-year-old Luis Figueroa ran his first marathon.
Successfully completing this long-distance race is a tremendous
accomplishment for any runner, but for Figueroa, crossing the finish
line was nothing short of a miracle: Just 10 months earlier, Figueroa
had suffered a near-fatal episode of cardiac arrest at the end of a
short race. Happy to be alive, he thought his marathon quest was over.
But a novel procedure enabled Figueroa to achieve his ambitious goal,
finishing the 26.2 mile race, free of chest pain — and free of worry.
Off and Running
Luis Figueroa (right) first caught the running bug about three years ago.
“I was middle-aged and out of shape,” says Figueroa. “My wife is a runner
and she kept encouraging me to take up the sport.”
Starting off slowly, Figueroa, a director in GE’s Digital Business Unit,
began running a mile on the treadmill. As the weather improved, he moved
outside and doubled his distance to two miles. He then successfully
completed a 5K road race near his home in Merrimack, NH. He distinctly
remembers how proud he felt the first time he ran 10 miles non-stop at a
9:08 minute pace.
“It was an important milestone,” he says.
He was hooked. The father of three had lost 65 pounds and was routinely
finishing races in the top 10 for his age group. After receiving a clean
bill of health from his doctor, he decided that 2016 would be the year he
would run a marathon.
But on New Year’s Day, after finishing the Millennium Mile, a popular “fun
run” in Londonderry, NH, Figueroa collapsed. He was in full
“It’s everyone’s worst nightmare, suddenly collapsing and being rushed to
the hospital,” says interventional cardiologist
Robert Yeh, MD, MSc
, Director of the Coronary Chronic Total Occlusion Program in Beth Israel
Deaconess Medical Center’s
Cardiac arrest is the abrupt loss of heart function, resulting when the
heart’s electrical system malfunctions, and is often fatal. In Figueroa’s
case, it was his first sign of a heart problem.
As terrifying as this episode was, says Figueroa, it proved to be an
important warning sign.
It was eventually revealed that he had a chronic total occlusion, an artery
in the heart that is 100 percent blocked.
This unexpected discovery brought Figueroa to BIDMC, where he met Yeh, one
of the country’s leading experts in complex, non-surgical interventions for
patients with these extreme blockages.
Together with Associate Chief of Interventional Cardiology
Duane Pinto, MD, MPH
, Yeh performed a procedure called a Chronic Total Occlusion-Percutaneous
Coronary Intervention (CTO-PCI) on Figueroa in June 2016, opening the
blocked artery and restoring his heart to maximum efficiency.
Just four months later, on October 16, 2016, Figueroa fulfilled his New
Year’s resolution, completing the Baystate Marathon in Lowell in 4 hours,
35 minutes — just five minutes over the goal he had set for himself before
The Importance of Family History
Heart disease is the most common chronic condition in the United States,
affecting more than 27 million people. The risk factors are well-known:
high blood pressure, high cholesterol, excess weight, inactivity. But, says
Yeh, there are many people like Figueroa who lead healthy lifestyles, eat
well, exercise regularly and have no outward symptoms — and still develop
“Heart disease can affect seemingly healthy people based on genetics and
family history,” says Yeh.
Both of Figueroa’s parents had undergone bypass surgery to treat blocked
Figueroa considers himself lucky. The runner at his side when he collapsed
during the New Year’s Day race happened to be a former EMT who immediately
began administering CPR. Figueroa was soon resuscitated and taken by
ambulance to Parkland Medical Center in Londonderry, NH, where a cardiac
catheterization revealed several blockages of the heart’s arteries, one of
which was treated with a stent to open the coronary artery.
Shortly thereafter, Figueroa was transferred to Catholic Medical Center in
Manchester, NH, where he was implanted with a defibrillator, a device that
keeps track of heart rate and can deliver an electric shock if the heart is
beating chaotically and too fast.
“One of my main blockages was cleared,” says Figueroa. “There was a second
artery that was blocked 100 percent, but the doctor recommended that I wait
a few months before undergoing any further treatment. Of course, I wanted
to know if I could still run. I remember my doctor told me, ‘You’re cleared
to run races, just don’t try to win them.’”
Figueroa took him at his word and had his sneakers laced up in no time. But
after warming up for the Millennium Running Club’s Cinco de Mayo Road Race
in May, he felt something wasn’t quite right. Later on, the readout from
his defibrillator would indicate that he had experienced an episode of
ventricular tachycardia, a potentially lethal arrhythmia.
Back at the hospital, a stress test revealed that the bottom portion of his
heart — where the fully blocked chronic total occlusion was located — was
under duress. Figueroa was transferred from Catholic Medical Center to
BIDMC, one of the few centers in New England specializing in the complex
treatments needed to manage these complicated blockages.
Breaking Out of Coronary Gridlock
“In most cases, a blocked coronary artery is like a traffic jam on the
highway,” explains Yeh. “Even when there’s heavy traffic, it’s likely that
one of the highway’s five lanes is still open. This is the case of a
typical coronary blockage of approximately 80 percent — it’s like one lane
is moving and four lanes are closed. So, you can still see that there’s a
pathway to perform angioplasty, or to get out of the traffic jam.”
But, says Yeh, in Figueroa’s case, the blockage was the equivalent of
gridlock across all five lanes, leaving no channel at all for the artery to
be opened through typical angioplasty.
“We first tried using a wire-based strategy to try and go straight through
the blockage, but quickly realized that wasn’t going to work for Mr.
Figueroa,” explains Yeh. “So we flipped rather quickly to doing a
‘retrograde’ procedure. With this technique, you enter through a blood
vessel that isn’t blocked, but is supplying vessels to the back side of the
blocked artery. By taking advantage of these collateral blood vessels, we
were able to open the blockage from the back side — finding a totally
different route around the gridlock to open the blockage against the ‘flow
Complex CTO PCI techniques such as ‘retrograde’ procedures are performed at
only a small number of centers across the country.
The procedure was successful. By the next day, Figueroa was feeling much
better. Within a week, he was carefully exercising and had once again
focused his attention on the upcoming marathon.
A Return to the Race Course
“This was a very important part of Mr. Figueroa’s life and we wanted to
give him the best opportunity to achieve this goal,” adds Yeh. “This was
not something he would have been able to do with his heart under duress.”
“You have to begin training about 14 to 16 weeks prior to a marathon, which
meant that in order to compete in the Bay State race in the fall, I was
going to have to get started in July,” says Figueroa. “I had the CTO-PCI
procedure on June 13th, went home the next day, and immediately
felt a noticeable difference. I was able to train throughout the summer,
logging as many as 49 hours a week and completing the long 18-mile two- to
three-hour runs without having any chest pain.”
On October 17, Dr. Yeh received an email message. The subject line read “A
Big THANK YOU – I Did It!”
“Dr. Yeh, A big thank to you and Dr. Pinto for getting me cleared up
and fixed to run … My goal time was 4:30 and I ended up just five
minutes over so I am pleased. I ran strong first half under 10 min pace
for the first 16 miles and ended with average pace for 10:30 which is
not bad for a first-timer. I could not have done this had it not been
for the skillful work you did. To be able to complete a marathon after
collapsing and being in cardiac arrest, I have you to thank.”
Today, Figueroa continues to receive anti-platelet medication to prevent
clots from developing in his stented artery, and continues to eat well and
maintain his healthy lifestyle. And after recovering from his October
marathon, he continues to run shorter road races.
“I’ll probably always be a runner,” he says, adding, “One of the most
important lessons I learned when it comes to heart health is to make sure
you’re aware of your family history.”
Above content provided by the CardioVascular Institute at Beth Israel
Deaconess Medical Center. For advice about your medical care, consult