Chronic Total Occlusion

Blockage that limits your heart's blood supply

Our approach to chronic total occlusion care

Chronic total occlusion (CTO) is a condition in which at least one major artery supplying blood to the heart is completely blocked for three months or longer. CTO can cause chest pain, shortness of breath, fatigue and other symptoms. In some cases, CTO can lead to a heart attack.

That's why our CTO experts go the extra mile to give your heart the best possible care. We'll perform a comprehensive review of your medical history and previous test results and run additional tests to determine possible treatment options for you.

Signs and symptoms of CTO

When your heart doesn't get the blood it needs, you'll feel it, with or without physical effort. Symptoms of CTO can include:

  • chest pain, pressure or tightness
  • shortness of breath
  • dizziness or fainting
  • fatigue
  • nausea
  • pain in the upper body and arm
  • rapid or irregular heartbeat

When to seek care for chronic total occlusion

If you're consistently feeling the symptoms above, it's important to see a doctor right away. These are signals that you could have a serious condition — and time is of the essence.

Our steps to a diagnosis

Diagnosing CTO involves several steps to carefully rule out other heart conditions and find the source of the problem. Our thorough evaluation includes:

  • medical history: We'll ask you about your symptoms, risk factors and personal and family medical history.
  • physical exam: We'll perform a physical exam to check your vital signs, listen to your heart and lungs and check for any problems.
  • electrocardiogram (EKG): An EKG records the electrical activity of your heart. It can show if you have a heart rhythm disorder or other heart problems.
  • echocardiogram: Also called a heart ultrasound, an echocardiogram uses sound waves to create images of your heart. It can show how well your heart is pumping and any structural problems.
  • cardiac catheterization: In this diagnostic procedure, our heart specialists insert a thin tube into an artery in your arm or leg and thread it to your heart. This test allows us to see the inside of your arteries and check for blockages.

Our treatment options

WellSpan’s heart specialists offer many treatment options for CTO, including medication, minimally invasive procedures and surgery. The best treatment option for you will depend on your individual circumstances. Our highly skilled team will work closely with you and tailor your treatment plan to your unique symptoms and risks.

Common treatment options for CTO include:

  • CTO percutaneous coronary intervention (CTO PCI): Our experienced cardiac interventionalists, who have advanced training in treating CTO, perform this minimally invasive procedure. During CTO PCI, they place a small mesh tube (stent) within the blocked artery to widen it and restore blood flow. CTO PCI has a high success rate, with a survival rate of nearly 90 percent.
  • Coronary artery bypass grafting (CABG): If you're not a good candidate for CTO PCI, open-heart surgery may be a treatment option for you. The CABG procedure involves sewing (grafting) a healthy blood vessel from another part of your body into your heart. The grafted vessel creates a new route for blood to flow around the blockage.
  • Medication therapy: Our heart specialists may prescribe medications to manage symptoms and reduce the risk of complications. These may include anti-anginal medications, beta-blockers, calcium channel blockers and nitrates.
  • Lifestyle changes. Adopting heart-healthy lifestyle habits can help improve your overall cardiovascular health and reduce the risk of further blockages. Some healthy habits include regular exercise, a balanced diet, weight management, smoking cessation and stress reduction.

It's important to discuss the risks and benefits of each treatment option with your doctor, so together you can make an informed decision about your care. 

Benefits of treating CTO

Treating CTO is important to ensure that we improve lifestyle-limiting symptoms, such as angina (chest pain). Ultimately, our goal is to give you lasting results, reducing your risk of coronary artery disease (CAD) complications in the future. 

Tests and treatments

  • physical exam
  • EKG
  • echo
  • catheterization
  • angioplasty
  • CABG

Noteworthy CTO PCI performance

Our cardiac interventionalists are among the few cardiologists in the United States who can perform the full range of CTO PCI procedures, including treatment of the most complex cases. Our CTO PCI success rate is among the highest in the country, and our patients experience exceptional outcomes.

Advanced techniques and technology

We use the latest techniques and technology to diagnose CTOs, including intravascular ultrasound (IVUS) and fractional flow reserve (FFR). These technologies allow us to precisely identify and treat blockages, resulting in better outcomes.

Personalized treatment plans

We understand that every person is different, which is why we tailor your treatment plan to you and your unique needs. We work closely with you to ensure that you understand your condition and are comfortable with your treatment plan.

Comprehensive care options

We offer a full range of services around CTOs, including diagnostic testing, medication therapy and surgical intervention. We also provide support services, such as cardiac rehabilitation and education, to help you manage your condition and improve your quality of life.

Latest and greatest

We participate in clinical trials for new and innovative treatments for CTOs. This means you have access to the latest and most advanced treatments available. In addition, we operate one of the highest-volume cardiac catheterization labs in the region and have developed treatment pathways for safe and successful CTO procedures.