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Chronic Total Occlusion (CTO) Opening

A Chronic Total Occlusion (CTO) Opening, or CTO PCI, is a minimally invasive interventional cardiology procedure used to treat Chronic Total Arterial Occlusions (CTOs) in the coronary arteries, which supply blood to the heart. CTO refers to a coronary artery that has been completely closed for at least three months. These blockages can lead to chest pain, shortness of breath, and other symptoms. 

What is a Chronic Total Occlusion Opening?

In a Chronic Total Occlusion (CTO) opening, highly-skilled interventional cardiologists use state-of-the-art technology to navigate a thin, flexible catheter through the blood vessels to reach the site of the occlusion. The procedure is performed to help improve moderate-severe symptoms from coronary artery blockage. Using real-time imaging, interventional cardiologists thread a guidewire through the blockage, and a specialized balloon catheter is carefully inflated to compress the plaque and restore blood flow. A stent is then inserted to maintain the artery's patency. This opens the blocked artery, restores blood flow, and can alleviate these symptoms, improving the patient's quality of life. This innovative procedure has revolutionized the management of complex coronary artery disease, providing hope to patients with previously limited treatment options.

Risks vs. Benefits of Chronic Total Occlusion Procedure

The Chronic Total Occlusion (CTO) Procedure presents a unique balance between risks and benefits, with the potential for significant advantages in certain patients. While every medical procedure carries inherent risks, the benefits of the CTO Procedure can often outweigh the potential complications, making it a suitable treatment option for select patients.

Benefits of Chronic Total Occlusion (CTO) Procedure

  • High success rates
    With advancements in technology and expertise, success rates using the CTO Procedure to open blocked arteries have become quite high. The CTO procedure is a very viable treatment option for patients with limited alternatives.
  • Improved quality of life
    The CTO Procedure can improve the patient's quality of life by relieving symptoms such as chest pain and shortness of breath. It can also help to improve the patient's exercise capacity and overall well-being.
  • Minimally invasive
    The CTO Procedure is a minimally invasive procedure that can be performed under local anesthesia. This means that there is less pain and scarring associated with the procedure.
  • Lower complication rates
    With advancements in interventional cardiology techniques and equipment, the risk of complications during the CTO Procedure has significantly decreased. When experienced interventional cardiologists perform the CTO Procedure, overall complication rates are low.
  • Alternative to open-heart surgery
    For patients who are not suitable candidates for coronary artery bypass graft (CABG) surgery, the CTO Procedure can offer a viable alternative. It allows patients with complex coronary artery disease to receive effective treatment without undergoing the extensive trauma associated with open-heart surgery.

Risks of Chronic Total Occlusion (CTO) Procedure

  • Periprocedural Complications
    There is a small risk of complications occurring during or immediately after the procedure, such as bleeding or bruising at the catheter insertion site, myocardial infarction, and vessel perforation, which can usually be closed with a stent if it occurs.
  • Bleeding
    There is a risk of bleeding at the site of the procedure. This can be controlled with medication.
  • Infection
    There is a risk of infection at the site of the procedure. This can be treated with antibiotics.
  • Stroke
    There is a small risk of stroke associated with the CTO procedure. This risk is higher in patients with certain medical conditions, such as diabetes and high blood pressure.
  • Restenosis
    In some cases, the artery may narrow again after the procedure. This is known as restenosis.

What to Expect Before, During, and After Chronic Total Occlusion Procedure

The Chronic Total Occlusion (CTO) Opening is a minimally invasive procedure that can be performed under local anesthesia. The procedure typically takes 2 hours to complete, and patients usually go home the same day or the day after the procedure.

You will have an initial consultation with our interventional cardiologist to review your medical history and conduct diagnostic tests. During the procedure, a specialized catheter will be inserted through an artery to reach the blocked coronary artery. Our cardiologist will use advanced imaging and tools to navigate a wire through the catheter and create a pathway through the blockage, use a small balloon to open the artery and then insert a stent to keep the artery open. 

After the procedure, you will be closely monitored for a short recovery period, and many patients can go home on the same day. Follow-up appointments will be scheduled to monitor your progress and ensure the effectiveness of the CTO Procedure, with personalized guidance on recovery and lifestyle adjustments to support your cardiovascular health. Here are a few other things to keep in mind:

  • You will likely be prescribed medications to manage pain, prevent clotting within the stent, and support your heart health.
  • You may experience some pain and fatigue after the procedure. 
  • You will need to keep the stapled or stitched incision site clean and dry.
  • You will need to see your doctor for follow-up appointments to make sure that the procedure was successful and that there are no complications.
  • Your doctor will likely recommend that you make some lifestyle changes including eating a healthier diet, exercising regularly, and quitting smoking, as part of the management of your coronary artery disease.

Am I a Candidate for Chronic Total Occlusion Procedure?

Your cardiovascular specialist will determine whether you are a suitable candidate for a procedure to open a Chronic Total Occlusion (CTO) in one of your coronary arteries. This requires a thorough evaluation by your healthcare team. While each individual case is unique, several factors play a crucial role in assessing candidates for the procedure. Your cardiologist will consider the following aspects to uncover whether or not you’re eligible for the procedure:

  • Suitability of the Chronic Total Occlusion (CTO) for Opening
    Many, but not all, CTOs can be opened through this procedure. Your cardiologist will evaluate whether you have a CTO — which is a blockage in a coronary artery that has been present for at least three months — and will then evaluate whether the CTO is one that has a good chance of being opened with the CTO procedure.
  • Symptom Severity
    Your doctor will evaluate the severity of your symptoms related to the CTO. Common symptoms include chest pain (angina), shortness of breath, fatigue, and reduced physical activity capacity.
  • Medical History
    Your overall medical history, including any pre-existing health conditions, previous heart procedures, and current medications, will be reviewed to assess how they may impact the CTO procedure.
  • Extent of Blockage
    The location, length, and complexity of the occlusion are significant factors that influence candidacy. Some CTOs may be more challenging to treat, affecting the potential success of the procedure.
  • Heart Function
    Your heart's overall function, measured by tests like echocardiography or stress testing, helps determine if the CTO procedure can improve blood flow and alleviate symptoms.
  • Risk Tolerance
    Your doctor will discuss the risks and benefits of the CTO procedure with you. Understanding and accepting the potential risks is essential when considering the best treatment option.
  • Lifestyle and Activity Level
    Your lifestyle habits and activity level are taken into account to evaluate how the CTO procedure may impact your daily life and long-term health.

Find Out if the Chronic Total Occlusion Procedure Can Help You

By restoring blood flow to the heart muscle, the CTO procedure can help reduce chest pain, improve exercise capacity, and increase your overall well-being. If you are diagnosed with a Chronic Total Occlusion (CTO) and have significant symptoms that are not responding to medications, request an appointment with our esteemed cardiovascular specialists to find out if the CTO procedure can help. 


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