Chronic Total Occlusion Treatment

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Chest pain? Trouble breathing? These are signs of coronary artery disease (CAD), the most common type of heart disease in the U.S. If you’re feeling any of these symptoms, you may have a blockage in one or more of your coronary arteries. For some people, their CAD progresses to include chronic total occlusion (CTO).

Having CTO means that one or more of the arteries that bring oxygen-rich blood to your heart has been completely blocked for some time (a chronically occluded artery). There isn’t any blood flowing to your heart through that artery by the normal route. And, it’s been that way for at least 3 months. That can lead to a heart attack.

Chronic Total Occlusion Treatment at UVA Health

We're here to help. At UVA Health, our heart care team is deeply experienced in working together to treat CTO. We use advanced techniques, the latest tools, and a team approach to make sure you get the best care possible. We have a high success rate (about 90%) and a very low complication rate for catheter-based procedures to treat a CTO. That's one of the reasons our heart attack and heart bypass surgery care have received the highest scores from U.S. News & World Report.

Although some patients won’t show any symptoms, CTO can cause:

  • Shortness of breath
  • Chest pain 

CTO is common in people with CAD. About 20% to 25% of CAD patients get it. Treatment is focused on improving symptoms. That usually starts with medication.

If medications don’t improve your symptoms, you may be a candidate for a catheter-based procedure.

Catheter-Based Treatment

Catheter-based treatment is a special form of angioplasty. During angioplasty, your doctor puts a catheter (a small, flexible tube) into your artery. The catheter brings special tools to the blockage to open it. We’re one of the few hospitals treating CTO using this technique, which avoids major surgery with large cuts on your body and a long recovery.

Unlike with bypass surgery, you should be able to return to your normal activities in as little as a week after the procedure. And, this method has an 80-90% success rate. A good candidate for this procedure has a chronically occluded artery that is healthy and open beyond the blockage. 

Bypass Surgery

The techniques used to open chronically occluded arteries are challenging. Not everyone is a good candidate for catheter-based treatment. Your arteries may have been completely blocked for a very long time. That can make them difficult to treat with catheter-based procedures. If that's the case, bypass surgery may be best for you.

During bypass surgery, surgeons take a blood vessel from another part of your body. They use it to create a new blood vessel in the area beyond where your artery is blocked. This restores blood flow to that area.

A Patient's Symptoms

Jim Rohan didn't know his shortness of breath meant his life was in danger. Hear Jim talk about his symptoms and getting CTO treatment. View CTO transcript.

Symptoms & Risk Factors of CTO

CTO is common in people with CAD or those who have already had a heart attack. The symptoms of CTO can be similar to other heart and artery problems:

  • Chest pain
  • Fatigue 
  • Unable to exercise

Risk factors for getting CTO are the same as for other forms of blockage and include:

  • A family history of CAD 
  • Smoking or other tobacco use
  • Diabetes 
  • High cholesterol

To check you, your doctor may pass a heart catheter through your coronary arteries to check if they are blocked.