What Is a Coronary Chronic Total Occlusion?

CTO stent

Coronary arteries with severe blockages — up to 99% — can often be treated with a traditional stenting procedure. However, 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. 

Cardiovascular Institute of the South (CIS) has a number of physicians with training and expertise to safely and effectively open coronary CTOs. Opening coronary CTOs has been shown to improve symptoms of coronary artery disease, improve heart muscle pump function, 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 this condition, the lining of arteries is damaged and narrowed over time as fatty deposits collect and plaque develops. This process is known as atherosclerosis. If this process develops slowly enough, a vessel can become 100% blocked.

The artery will then be filled by new small vessels called “collaterals.” This is the body’s way of naturally bypassing the artery to keep the heart muscle alive. Unfortunately, these new collateral vessels are often inadequate to provide the additional blood flow needed for physical exertion. Patients with CTOs often feel chest pain, experience shortness of breath, and have poor exercise tolerance. 

What Are the Risk Factors Associated With Chronic Total Occlusion?

Risk factors associated with chronic total occlusion include:

How Is Chronic Total Occlusion Diagnosed?   

ultrasound machine

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:

  • Echocardiogram – An echocardiogram, or "echo" for short, uses ultrasound technology to provide active images of the heart, chambers, and valves. Patients experiencing health issues related to weakened heart muscle (congestive heart failure) who have coronary artery disease often have CTOs. 
  • 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.
  • Angiography – Ultimately, patients with abnormal non-invasive testing will require either a computed tomography coronary angiogram or invasive coronary angiogram to diagnose a CTO.
How is Chronic Total Occlusion Treated? 

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

  • Medication – Prescription medications are the cornerstone of therapy for coronary artery disease and should always be initiated before any procedures are considered.
  • 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.
  • CTO Percutaneous Coronary Intervention (CTO-PCI) – Special techniques and wires are used to either get through or around the blockage despite the 100% occlusion. A balloon is then inflated within the coronary artery to widen it and improve blood flow. Stents are subsequently placed to keep the artery patent. 

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: Protected Percutaneous Coronary Intervention (Protected - PCI) and 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 afterward (heart attack, stroke, etc.)

Searching for Coronary Chronic Total Occlusion (CTO) Treatment Near You?

If you are a candidate for coronary total occlusion treatment, you deserve care from the skilled CTO physicians and cardiovascular specialists at Cardiovascular Institute of the South. Our team provides the most advanced CTO treatment options. We offer convenient locations in Louisiana and Mississippi, with CTO physicians available in Baton Rouge, the West Bank, Lafayette, and Houma. Contact us today to schedule an appointment and experience a new level of care.


 CTO Physicians