Chronic Total Occlusion (CTO): Chest Pains, Blocked Arteries
Chest pains and troubled breathing may be signs of blocked heart arteries, which can lead to chronic total occlusion. Cardiologist Michael Ragosta, MD, walks us through the symptoms and treatment options of CTO.
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Transcript
A chronic total occlusion refers to a blockage in a heart artery. So when we think about blocked arteries, an artery can block abruptly and that typically causes a heart attack. But arteries can block off somewhat slowly over time and not lead to abrupt and dramatic presentation like a heart attack. Patients often will have collateral blood flow, which means they develop blood flow from other arteries to supply the area where the blockage is developing.
One of the most common symptom is angina, which is the chest pain syndrome. Other symptoms are shortness of breath, that's a very common symptom of somebody with a chronic total occlusion. If collateral vessels are very, very well developed, patient may not have any symptoms, and so you may not even know that you have one. But when we do catheterizations for patients with chest pain syndromes, we often find chronic total occlusions on the order of anywhere from 15% to 20% of patients will have them.
The treatment options for chronic total occlusion include medical therapy, which is the first line therapy. These include things like the beta blockers and long-acting nitroglycerin drugs. The next line of therapy would be to do a catheter-based procedure. And here at UVA we specialize in these particular types of blockages. When catheter-based techniques either don't work or cannot be applied, then there's surgery as an option. That's open heart surgery, with a bypass operation. Patients with chronic total occlusions have very complex blockages. Most physicians in the general community won't be willing to take these blockages on because of their increased risk, but also because it does require a special set of skills, training and equipment that many centers don't have. Here at UVA, we do anywhere from 50 to 75 of these a year, which is a good number and our success rate is in excess of 90%.
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