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Coronary Artery Chronic Total Occlusion

  • Have you been told you need bypass surgery?
  • Have you been told that there is nothing else that can be done for you heart disease?
  • Are your blockages too complex to bypass?
  • Is your quality of life limited by your heart disease and blockages?

If you have been diagnosed with chronic total occlusion in one of your arteries, you have options. The physicians on the medical staff at Baylor Hamilton Heart and Vascular Hospital use advanced technology and proven techniques to treat your chronic total occlusion.

What is coronary artery disease?

Coronary artery disease occurs when the coronary arteries become narrowed or blocked as a result of atherosclerosis. Atherosclerosis is the build-up of fatty deposits and plaque on the inner walls of the arteries that restricts blood flow to the heart. Without adequate blood flow, the heart is starved of the oxygen and vital nutrients it needs to function properly. The most common symptom of coronary artery disease is angina or chest pain.

When one or more of the coronary arteries is completely blocked, a heart attack may occur, which damages the heart muscle. If the blockage occurs more slowly, the heart muscle may create small blood vessels that allow the other coronary arteries to reroute the blood flow. In this case, angina may occur.

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Coronary artery chronic total occlusion

Coronary artery chronic total occlusion (CTO) is complete or almost complete blockage of a coronary artery for 30 or more days. Coronary CTO is caused by a heavy build-up of atherosclerotic plaque within the artery.

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If you have coronary artery chronic total occlusion, you may experience:

  • Angina or chest pain
  • Pain in the upper body and arms, potentially concentrated on the left side
  • Jaw pain
  • Indigestion or choking feeling
  • Nausea
  • Dizziness or light-headedness
  • Cold sweat
  • Rapid or irregular heartbeat
  • Unusual fatigue

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Risk factors for CTO

If you have any of the following conditions, you may be at increased risk for coronary artery CTO:

  • Smoking or daily exposure to second-hand smoke, at home or at work
  • Past heart attack or known coronary artery disease
  • Family history of heart disease
  • High cholesterol
  • Postmenopausal status (women)
  • Taking birth control pills and smoking (women)
  • Being overweight
  • Diabetes
  • Hypertension (high blood pressure)
  • A sedentary or inactive lifestyle

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Diagnosing CTO

To diagnose a chronic total occlusion, a routine physical exam with a comprehensive medical history is performed. Physicians also may order X-rays, an EKG, stress tests, CT scan, MRI or an angiogram to fully understand your condition.

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Treating CTO

The physicians on the medical staff at Baylor Hamilton Heart and Vascular Hospital will personalize a treatment plan for each patient with CTO based on the severity of your symptoms, as well as your coronary artery disease.

Traditionally, most patients with CTO who have symptoms as noted above required coronary artery bypass graft (CABG) surgery to clear the blockage. In the past, total blockages of the coronary artery have been difficult to clear with interventional procedures.

However, with the advent of advanced technology and innovative percutaneous (performed through a needle stick through the skin) techniques, interventional cardiologists are improving the outcomes of percutaneous coronary intervention, making it a viable option for some patients who are experiencing symptoms related to their CTO.

Interventional cardiologists now are able to gently steer special guide wires and catheters across the blockages. New technology makes fine movement of the guide wire tip much easier to control than in the past.

In the last few years, the success rate of the combined percutaneous approach has increased from about 60 percent to 80 to 85 percent. This is in comparison to the success rate of about 98 percent for percutaneous treatment of non-total blockages. Although the percutaneous approach has potential complications, the complication rate is comparable to that of standard angioplasty (about 1 percent).

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Potential Benefits of Chronic Total Occlusion Percutaneous Coronary Intervention

Percutaneous coronary intervention of CTO may result in improvement in symptoms, improvement in left ventricular function and overall improvement in survival.

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