Chronic coronary total occlusion (CTO) occurs when plaque blocks either the left or right coronary artery for more than 90 days. This prevents a healthy amount of oxygen from reaching the heart.
Leaving CTO untreated can cause chest pain and fatigue. It can also lead to lifestyle restrictions.
Experts believe approximately 30% of people with coronary artery disease have a CTO.
Chronic Coronary Total Occlusion Risk Factors
People who have had bypass surgery or a previous heart attack are more likely to develop CTO.
Some factors are beyond control, including:
- Age (45 years for men, 55 for women).
- A family history of heart disease.
Other factors are more within your control, such as:
- Being overweight or obese.
- Diabetes.
- Eating a diet high in fat and cholesterol.
- Excessive alcohol use.
- High blood pressure.
- High cholesterol.
- Lack of exercise.
- Tobacco use.
Chronic Coronary Total Occlusion Symptoms
People living with CTO may experience symptoms such as:
- Chest pain.
- Fatigue.
- Shortness of breath.
Early stages of CTO may show no symptoms at all.
Diagnosing Chronic Coronary Total Occlusion
Experts at the UPMC Heart and Vascular Institute use cardiac catheterization and angiography imaging to diagnose CTO.
As part of this process, a provider will:
- Insert a catheter into a blood vessel in the wrist or leg.
- Move the catheter through that vessel until it reaches the heart.
- Inject a dye into the blood vessels of the heart. This dye is visible on x-rays, allowing the provider to see blood flow through the heart and its arteries. This will ultimately identify whether CTO is present.
Chronic Coronary Total Occlusion Treatment
The goal of CTO treatment is to restore blood flow through the blocked artery to the heart.
In most cases, surgery is avoidable with the use of angioplasty and stenting.
For this treatment, an interventional cardiologist will:
- Insert a guide wire and advance it through arteries to the blockage using fluoroscopy (a type of moving x-ray that shows blood vessels on a monitor).
- Advance a catheter sheath wire and insert a catheter with a balloon at its tip through the catheter sheath.
- Inflate and deflate the balloon until it flattens the blockage against the artery wall.
- Place a stent to expand against the artery walls and act like a scaffold to make sure the artery stays open.
If bypass surgery is necessary, the surgeon will make a chest incision to gain access to the heart and blood vessels. They’ll attach one end of a blood vessel taken from another part of the body (or from a cadaver) to one end of the blocked artery above the blockage. They’ll then attach the other end below the blockage.
Blood will then bypass the blockage and flow through the newly attached blood vessel, restoring blood flow to the heart.
Whether treatment is nonsurgical or surgical, experts at the UPMC Heart and Vascular Institute work with patients to develop the best possible care plan for each situation.
For more information or to schedule an appointment, call 1-855-876-2484, email HeartAndVascular@UPMC.edu, or fill out our contact form.