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Chronic Total Occlusion

1) What is Coronary artery chronic total occlusion?
Coronary artery chronic total occlusion (CTO) is complete or almost complete blockage of a coronary artery for 30 or more days. Coronary CTO is caused by a heavy build-up of atherosclerotic plaque within the artery.

2) What are the risk factors for CTO?
If you have any of the following conditions, you may be at increased risk for coronary artery CTO:

  • Smoking or daily exposure to second-hand smoke, at home or at work
  • Past heart attack or known coronary artery disease
  • Family history of heart disease
  • High cholesterol
  • Postmenopausal status (women)
  • Taking birth control pills and smoking (women)
  • Being overweight
  • Diabetes
  • Hypertension (high blood pressure)
  • A sedentary or inactive lifestyle

3) How is a CTO diagnosed?
To diagnose a chronic total occlusion, a routine physical exam with a comprehensive medical history is performed. Physicians also may order X-rays, an EKG, stress tests, CT scan, MRI or an angiogram to fully understand your condition

4) How is a CTO treated?
Traditionally, most patients with CTO who have symptoms as noted above required coronary artery bypass graft (CABG) surgery to clear the blockage. In the past, total blockages of the coronary artery have been difficult to clear with interventional procedures. However, with the advent of advanced technology and innovative percutaneous (performed through a needle stick through the skin) techniques, interventional cardiologists are improving the outcomes of percutaneous coronary intervention, making it a viable option for some patients who are experiencing symptoms related to their CTO.
Interventional cardiologists now are able to gently steer special guide wires and catheters across the blockages. New technology makes fine movement of the guide wire tip much easier to control than in the past.In the last few years, the success rate of the combined percutaneous approach has increased from about 60 percent to 80 to 85 percent. Although the percutaneous approach has potential complications, the complication rate is comparable to that of standard angioplasty (about 1 percent).