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.
CTO: Chest Pains, Blocked Arteries
Chest pain and troubled breathing may be signs of blocked arteries in your heart, which can lead to CTO. Michael Ragosta, MD, walks through the symptoms and treatment options of CTO an UVA Health.
A chronic total occlusion refers to a blockage in a heart artery. So, when we think about blocked arteries, an artery can block abruptly and that typically causes a heart attack. But arteries can block off somewhat slowly over time and not lead to an abrupt and dramatic presentation like a heart attack. Patients often will have collateral blood flow, which means they develop blood flow from other arteries to supply the area where the blockage is developing. One of the most common symptoms is angina, which is the chest pain syndrome. Other symptoms are shortness of breath; that's a very common symptom of somebody with a chronic total occlusion. If collateral vessels are very, very well developed, the patient may not have any symptoms, and so you may not even know that you have one. But when we do catheterizations for patients with chest pain syndromes, we often find chronic total occlusions on the order of anywhere from 15% to 20% of patients will have them. The treatment options for chronic total occlusion include medical therapy, which is the first line therapy. These include things like the beta blockers and long-acting nitroglycerin drugs. The next line of therapy would be to do a catheter-based procedure. And here at UVA we specialize in these particular types of blockages. When catheter-based techniques either don't work or cannot be applied, then there's surgery as an option. That's open heart surgery, with a bypass operation. Patients with chronic total occlusions have very complex blockages. Most physicians in the general community won't be willing to take these blockages on because of their increased risk, but also because it does require a special set of skills, training, and equipment that many centers don't have. Here at UVA, we do anywhere from 50 to 75 of these a year, which is a good number, and our success rate is in excess of 90%.
Treat Your CAD, Prevent a Heart Attack
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.