Chronic total occlusion FAQs

The coronary arteries–blood vessels that wrap around the outside of the heart–carry oxygen-rich blood to the heart. The heart muscle needs oxygen to stay healthy and work properly. 

Certain lifestyle choices, medical problems, and genetics can damage the coronary arteries and cause plaque to build up and narrow the insides of these arteries, making it harder for blood to reach the heart. This narrowing is called coronary artery disease (CAD). 

What is chronic total occlusion? 

A chronic total occlusion (CTO) is a complete, or nearly complete, blockage of one or more coronary arteries, lasting at least three months, caused by a buildup of plaque–a fatty substance in the bloodstream that narrows the arteries. 

Patients with coronary artery disease (CAD) are more likely to have a CTO. 

How common is chronic total occlusion? 

CTO is very common, occurring in as many as 1 in 3 patients with significant CAD. The chance of getting a CTO increases as people get older. 

Risk factors for chronic total occlusion 

The risk factors for CTO are the same as CAD, including: 

• Previous heart attack
• Smoking
• High blood pressure
• High cholesterol
• Diabetes
• Body mass index (BMI) of 30 or higher
• Inactive lifestyle
• Family history of heart disease 

Chronic total occlusion symptoms 

CTO symptoms often worsen during activity and lessen during rest. However, you may experience symptoms while at rest or have no symptoms at all. 

• Shortness of breath (with activity and while at rest)
• Chest pain or tightness
• Fatigue
• Dizziness
• Irregular heartbeat
• Nausea
• Upper arm pain
• Racing or rapid heartbeat 

How is chronic total occlusion diagnosed? 

CTO is diagnosed by doing a coronary angiogram–a procedure in which a catheter is threaded through a blood vessel in the wrist or groin to an artery in your heart and a dye is injected to show how blood moves through your arteries.  

Other tests may also be done, including: 

• Cardiac MRI
• Cardiac stress test
• Echocardiogram (echo)
• Electrocardiogram (ECG or EKG) 

Chronic total occlusion treatment options 

Treatment plans for CTO typically focus on improving blood flow, lowering symptoms, and reducing your risk of heart-related events, like a heart attack. The treatment will depend on the severity of your symptoms and any current treatments for CAD. With successful CTO intervention, patients typically experience immediate and dramatic symptom relief. 

• Percutaneous coronary intervention (PCI)
• Coronary artery bypass grafting (CABG) 

The minimally invasive treatment options are considered chronic and high-risk interventional procedures (CHIP). Our team of interventional cardiologists specialize in treating CTO and other complex coronary artery conditions.