What Is Chronic Coronary Total Occlusion?
Chronic coronary total occlusion (CTO) occurs when either the left main or right coronary artery — one of the arteries that delivers oxygen-rich blood to your heart — has become completely blocked or occluded for three months or longer.
Approximately 15 to 20 percent of people with coronary artery disease have a CTO.
Without treatment, a CTO can lead to:
- Chest pain (called angina)
- Shortness of breath
- Inability to participate in many normal daily activities
Causes and complications of chronic coronary total occlusion
Atherosclerosis, also known as hardening of the arteries, causes CTO.
Healthy arteries are flexible and smooth and allow blood to flow freely through them.
In atherosclerosis, fatty deposits and calcium can build up along the inner artery walls and form plaque. Over time, the buildup of plaque causes the arteries to narrow. This limits the amount of oxygen-rich blood that flows to the heart.
With CTO, the artery blockage is usually gradual. Because it happens over time, the body often adapts by creating small blood vessels that circumvent the blockage. The “collaterals” (or detours) form a natural bypass of the blockage by connecting the area of the heart that gets enough blood flow to the end of the vessel that is chronically occluded.
This re-routed blood flow helps deliver blood to the heart — partly making up for the blocked artery and usually protecting a person against a heart attack. However, this collateral circulation often does not supply enough blood to meet increased demand during exercise.
When a person with CTO increases his or her level of exertion, the result can be shortness of breath or chest pain.
Chronic coronary total occlusion risk factors
People who have had a previous heart attack or bypass surgery are more likely to develop CTO.
Like other forms of heart disease, you can control some risk factors but not others.
Factors you cannot control include:
- Family history, such as if your parents or siblings had heart disease
- Age (45 years for men, 55 for women)
Risk factors for heart disease you can control include:
- Tobacco use
- Being overweight or obese
- High blood pressure
- High cholesterol
- Eating a diet high in fat and cholesterol
- Not exercising
- Excessive alcohol use
Why choose UPMC for CTO treatment?
Historically, angioplasty and stenting was not an effective treatment for CTO. People either had bypass surgery or received medication to treat their CTO.
In recent years, angioplasty equipment and techniques have improved greatly, and it is becoming an option for many people with CTO. In fact, the UPMC Heart and Vascular Institute is the only center in western Pennsylvania that offers a program dedicated to angioplasty treatment for CTO.
Our interventional cardiologists have developed the experience and skill necessary to perform this technically demanding procedure with very high success rates that are on par with other dedicated CTO centers nationally.
Learn More About Chronic Coronary Total Occlusion
UPMC Heart and Vascular Institute