Chronic Total Occulsion

  • Has your doctor told you that you need bypass surgery?
  • Have you been told that your blockages are too complex or not indicated for open heart bypass surgery?
  • Have you been told that there aren’t any other options for your heart disease?
  • Has your heart disease affected your quality of life?

If you have been diagnosed with a Chronic Total Occlusion (CTO) of one of your coronary arteries, you do have options. At First Coast Heart & Vascular Center, our interventional cardiologists have special training and expertise in managing complex coronary artery disease. Specifically Dr. Van Crisco, in our practice has a wealth of experience in tackling Chronic Total Occlusions, with success rates nearing 90% for successful CTO revascularization.

What is coronary artery disease (CAD)?

Coronary artery disease (CAD) arises when the coronary arteries become blocked or narrowed due to atherosclerosis, or build-up of fatty deposits and plaque on the walls of the arteries.  CAD is the substrate for heart attack when a plaque disrupts form the vessel wall and closes a coronary artery. And CAD can impede blood flow to the heart sufficient to cause heart pain or angina. Deprived of adequate blood flow, the heart becomes depleted of the oxygen and crucial nutrients it requires to function properly. The most common symptoms of coronary artery disease are chest pain (angina), shortness of breath or even a heart attack.

What is a Chronic Total Occlusion or CTO?

A CTO is a blockage that has usually been present for more than three months. These blockages are a result of severe build-up of fatty deposits or plaque within the arteries and are one of the complications from coronary artery disease (CAD).  When a vessel closes slowly over time, the heart muscle it supplies gives off a hormone that causes an alternative blood supply to grow from another artery to keep the muscle alive.  We call this a collateral blood supply.  Parts of the heart supplied by collaterals often remain alive, but do not have enough blood supply to meet the muscle’s need with exercise, and often this causes angina or shortness of breath because of dysfunctional and starving heart muscle.

If you have CTO, you may experience:

  • Chest pain (Angina)
  • Pain in the upper body and arms, potentially concentrated on the left side
  • Pain in your jaw
  • Indigestion or a choking feeling
  • Cold sweat
  • Nausea
  • Dizziness or light-headedness
  • Rapid or irregular heartbeat
  • Extreme fatigue

What are the risk factors for Chronic Total Occulsion?

If you have any of the following conditions, you may be at increased risk for coronary artery CTO:

  • Past history of a heart attack or known coronary artery disease.
  • Smoking or daily exposure to second-hand smoke.
  • Family history of heart disease
  • High cholesterol
  • Postmenopausal status (women)
  • Using birth control pills and smoking (women)
  • Overweight
  • Hypertension (high blood pressure)
  • Diabetes
  • Leading a sedentary or inactive lifestyle.

Diagnosing Chronic Total Occulsion

In order to diagnose a chronic total occlusion your physician will perform a routine physical exam and get a comprehensive medical history from you. Your doctor may also order X-rays, an EKG, CT scan, stress tests, MRI or a coronary angiogram or heart catheterization to fully evaluate your condition.

Treating CTO

The physicians at First Coast Heart and Vascular Center will develop a personalized treatment plan for each patient diagnosed with CTO based on the severity of their symptoms, as well as their coronary artery disease.

Until recently, most patients with CTO who had severe symptoms required coronary artery bypass graft surgery to remove the blockage. Total blockages of the coronary artery had been difficult to clear with traditional interventional procedures.

Now, with the introduction of more advanced technology and innovative percutaneous catheter-based techniques, interventional cardiologists like Dr. Crisco have greatly improved the outcomes, making it a viable solution for many patients who are suffering from symptoms related to their CTO.

Today, interventional cardiologists now are equipped to gently maneuver special guide wires and catheters across the blockages. State-of-the-art technology makes small movement of the guide wire tip much less difficult to control than in the past.

Benefits of Chronic Total Occlusion Percutaneous Coronary Intervention

Successful percutaneous coronary intervention (PCI) of the CTO typically results in improvement in symptoms, resulting in less angina and fewer medications to treat angina.  Opening a CTO often also may show improvement in heart function and overall improvement in survival.

Because these arteries are closed, and have been for some time, the risks of CTO PCI are a bit higher than typical angioplasty and stent placement for non-occluded heart arteries. CTO PCI cases typically take longer to perform, require more than one vessel to access to complete the case safely, and expose the patient to more iodine contrast to visualize the arteries and more radiation exposure. Our experienced physicians at First Coast Heart & Vascular Center can counsel you more specifically about your own risk after angiography or heart catheterization is performed.