What is chronic total occlusion (CTO)?
A chronic total occlusion (CTO) is a complete or near-complete blockage in one or more coronary arteries that lasts three months or longer. The coronary arteries are the blood vessels that supply blood to the heart.
A CTO, also referred to as coronary occlusion or coronary artery occlusion, commonly develops in people with coronary artery disease. With the most experienced interventional cardiology experts in Pennsylvania and New Jersey, Penn Medicine offers advanced diagnostic tests and treatments to help find the cause of your CTO and create the right care plan for you.
What is a functional CTO?
Cardiologists often use the term “functional CTO” to describe a coronary artery that is severely but not completely blocked. They may use the term “true CTO” to describe a coronary artery that is completely blocked.
Your treatment plan may vary depending on whether you have a functional CTO or a true CTO. The more blocked or damaged your artery is, the more likely you’ll need a procedure to restore blood flow.
Chronic total occlusion symptoms
People with a CTO often experience more intense symptoms when they exert themselves and fewer symptoms when they’re at rest. CTO symptoms may include:
- Chest pain (angina), pressure, or tightness
- Dizziness
- Fatigue
- Heart palpitations, or sensations of your heart pounding
- Irregular heart rhythms (arrhythmia)
- Shortness of breath
If you experience any of these symptoms, contact your doctor right away. Timely diagnosis and treatment can improve blood flow to your heart and reduce your risk of complications.
Causes of chronic total occlusion
A chronic total occlusion usually develops when a fatty substance called plaque builds up in the coronary arteries. As the plaque hardens, your coronary arteries narrow.
You’re more likely to develop a CTO if you have certain conditions like diabetes, high blood pressure, or high cholesterol. A personal history of coronary artery disease or heart attacks, or a family history of heart disease, may also be contributing factors.
Some lifestyle habits also increase your risk of a CTO, including eating a diet high in sodium, having an inactive lifestyle, and smoking.
CTO complications
Without treatment, a CTO can increase your risk of a heart attack, a sudden blockage in blood flow to your heart. Your doctor may prescribe medications or recommend procedures designed to open the blockage, relieve symptoms, and reduce your risk of a heart attack.
Call 911 and seek emergency medical care right away if you experience any symptoms of a heart attack, such as:
- Chest pain
- Extreme fatigue
- Jaw, arm, neck, or back pain
- Lightheadedness
- Nausea
- Shortness of breath
The sooner you receive treatment, the less damage your heart muscle sustains.
Diagnosing a chronic total occlusion
Your doctor may recommend a variety of tests to make a CTO diagnosis. Imaging tests, like a heart MRI scan, can help show issues with the heart’s structure, while functional tests, like stress tests, can provide information about how well your heart is working. Other specialized tests can help pinpoint a CTO diagnosis.
Targeted treatments for chronic total occlusion
Your doctor will review the characteristics and symptoms of your chronic total occlusion along with your medical history to determine the best treatment plan for you. They’ll consider a range of options from minimally invasive procedures to open surgery. Treatments focus on reducing the risk of a cardiac event, while lessening symptoms of the CTO so you feel better.
Experts in specialized coronary care
The chronic total occlusion program at Penn Medicine is the premier program of its kind in the region. Our experts, with a designated subspecialty in CTO treatment, provide exceptional care while continually researching new treatment options to integrate into our care plans.
Our team offers tailored, advanced treatments that can shorten recovery times, reduce complications, and relieve your symptoms. These include minimally invasive angioplasty and stenting options not always available at other facilities. Our goal is to help you get back to your daily routine as soon as possible so you can live life to its fullest.