A Simple Explanation

This is complete or almost complete blockage of a blood vessel, usually the coronary artery for 30 days or more.

What is it?

Chronic Total Occlusions or CTO is a coronary heart disease where the coronary artery has complete or near complete blockage caused by heavy build-up of atherosclerotic plaque within the artery. In other words, this condition can also be described as the artery’s stenosis of 99% or more for a period of 1 to 3 months.

A coronary heart disease is the condition when the coronary arteries become narrowed or blocked due to atherosclerosis. The build-up of fatty deposits and plaque on the inner walls of the arteries cause atherosclerosis, in turn limiting the blood flow. The inadequate blood flow starves the heart of oxygen and other vital nutrients to function smoothly and can cause chest pain.


The usual symptoms experienced by patients of CTO are:

  • Angina or chest pain
  • Pain in upper body and arms, usually on the left side
  • Jaw pain
  • Indigestion or choking feeling
  • Nausea
  • Dizziness
  • Cold sweat
  • Irregular heartbeat
  • Unusual Fatigue

Risk Factors

The factors that might have caused CTO are:

  • Smoking, both active and passive smoking, is a main cause
  • Patients with family history of heart diseases
  • Previous heart attacks or coronary heart disease
  • High Cholesterol in blood
  • Post-menopause status in women
  • Patient’s Sedentary lifestyle
  • Overweight
  • Diabetes
  • Hypertension (High BP)

How to Diagnose CTO?

CTO is usually diagnosed by conducting a routine physical exam along with a complete medical history. Diagnostic tests like X-ray, ECG, Stress Tests, CT Scan, and MRI scan or an angiogram may also be performed to understand the condition completely.

,strong>Treatment of CTO

In the recent past, patients who showed the symptoms associated with CTO and after confirmation of the diagnostic tests undergo Coronary Bypass Graft (CABG) surgery. But now with newer technologies like Percutaneous Coronary Intervention, treatment of CTO has taken on a more positive role than before. PCI treatments include Angioplasty and Stenting.

PCI or Percutaneous Coronary Intervention has given an improvement in the symptoms, improvement in the function of the Left Ventricles and most important of all, the chances of survival has dramatically increased.

PCI like all the procedures does have its disadvantages. PCI makes use of significant use of catheterization, a longer time for procedure, which in results in more exposure to fluoroscopy. The increased use of catheters can result in irritation at the catheter insertion site and other discomforts. The longer exposure-time to Fluoroscopy increases the risk of radiation.

There are other means to manage and prevent CTO like:

  • Lifestyle Changes
  • Medical Treatment
  • The medications that are normally suggested for CTO are:

    • Statins to lower cholesterol and reduce the risk of CTO
    • Calcium Channel blockers or Beta-blockers to manage cardiac arrhythmias.
    • Anti-platelet drugs like aspirin

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