What is a Coronary Chronic Total Occlusion?


CTO stentCoronary arteries with severe blockages, up to 99%, can often be treated with traditional stenting procedure. Once an artery becomes 100% blocked, it is considered a coronary chronic total occlusion, or CTO. Specialized equipment, techniques and physician training are required to open the artery with a stent. CIS has a number of physicians with training and expertise to safely and effectively open coronary CTOs. Opening coronary CTOs have been shown to improve symptoms of coronary artery disease and improve quality of life in patients with this condition.  


How does CTO Develop?

Blockages of the coronary arteries, including CTOs, are the result of coronary artery disease.  In the condition, the lining of arteries are damaged and narrowed over time as fatty deposits collect and plaque develops.  This process is known as atherosclerosis.  

What are the risk factors associated with Chronic Total Occlusion?

The risk factors associate with Chronic Total Occulsion are:

  • Smoking
  • Medical history of coronary artery disease or heart attack
  • Family history of cardiovascular disease
  • High cholesterol
  • Diabetes
  • Obesity
  • High blood pressure (hypertension)

How is Chronic Total Occlusion Diagnosed?   

If a physician suspects that a total coronary artery blockage has occurred, they will order one or more of the following tests to confirm the diagnosis:

  • ultrasound machineCardiac MRI - A cardiac MRI provides a high-resolution image of the heart through the use of radio waves and a magnetic field.
  • Echocardiogram - An echocardiogram, or "echo" for short, uses ultrasound technology to provide active images of the heart, its chambers, valves and blood vessels.
  • Electrocardiogram - Also known as an EKG, an electrocardiogram records the heart's electrical signals, measure its rhythm, and identifies potential conduction issues.
  • Holter Monitor - If in-office procedures are unable to identify the problem, a holter monitor, or continuous EKG, may be worn to monitor a longer period of the heart's activity.
  • Nuclear Heart Scan - By inserting a small amount of radioactive material (tracers) through an IV, a nuclear heart scan can provide highly detailed, digital images of the heart.  A special camera captures images of the tracers as they travel through the cardiovascular system.
  • Stress Test - A stress test is an EKG that is conducted as the patient exercises on a treadmill or stationary bike.  As the heart rate increases, electrical signals may give new clues that are not detectable while at rest.

How is Chronic Total Occlusion Treated? 

There are several possible treatments for CTO.  Determining which is best will depend on the patient, their current health and medical history.

  • Coronary Artery Bypass Grafting (CABG) – This bypass surgery allows an artery or vein from another area of the body to be used to make a detour for blood to flow around the blockage.
  • Percutaneous Coronary Intervention (PCI) – A balloon is inflated within the coronary artery to widen it and improve blood flow.  Typically, a stent is also used to keep the artery open and supported. 
  • Atherectomy  A catheter outfitted with a small, rotating blade or laser is used to clear plaque buildup from the affected artery.
  • Medication – Prescription medications may be used to help control the symptoms associated with CTO.

How is CTO Treated in High-Risk Patients?

Many patients, either due to preference, comorbid conditions, weak heart muscle, or prior cardiac surgery are unable to get bypass surgery and their anatomy is too complex for traditional stenting. CIS has a comprehensive program available for patients to receive the best care possible with the most advanced technology without the need for open heart surgery. This often includes the use of two novel procedures (1) Protected Percutaneous Coronary Intervention (Protected-PCI) and (2) Coronary Chronic Total Occlusion Interventions (CTO-PCI).

What is Protected Percutaneous Coronary Intervention (Protected-PCI)?

Protected PCI is a newer, yet widely-used procedure using Impella®, the world’s smallest heart pump, to temporarily assist the pumping function of the heart. During a PCI procedure, the Impella® heart pump ensures blood flow is maintained to critical organs such as the brain, lungs, and kidneys. The heart is allowed to rest, as the pump takes over the job of efficiently moving the blood while the blockages in coronary arteries are being repaired.

What are the Benefits of Treating CTO with Protected-PCI?

  • Improvement in symptoms of coronary artery disease such as fatigue, shortness of breath, swelling or coughing
  • Faster recovery and a shorter hospital stay compared to traditional PCI or surgery
  • Fewer future visits to the hospital for heart related issues than traditional therapy
  • Reduced risk of major cardiovascular events afterwards (heart attack, stroke, etc.)


 CTO Physicians