Chronic Total Occlusion Treatment
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Chest pain? Trouble breathing? These are signs of coronary artery disease (CAD), the most common type of heart disease in the U.S. If you’re feeling any of these symptoms, you may have a blockage in one or more of your coronary arteries. For some people, their CAD progresses to include chronic total occlusion (CTO).
Having CTO means that one or more of the arteries that bring oxygen-rich blood to your heart has been completely blocked for some time (a chronically occluded artery). There isn’t any blood flowing to your heart through that artery by the normal route. And, it’s been that way for at least 3 months. That can lead to a heart attack.
Chronic Total Occlusion Treatment at UVA Health
We're here to help. At UVA Health, our heart care team is deeply experienced in working together to treat CTO. We use advanced techniques, the latest tools, and a team approach to make sure you get the best care possible. We have a high success rate (about 90%) and a very low complication rate for catheter-based procedures to treat a CTO. That's one of the reasons our heart attack and heart bypass surgery care have received the highest scores from U.S. News & World Report.
Although some patients won’t show any symptoms, CTO can cause:
- Shortness of breath
- Chest pain
CTO is common in people with CAD. About 20% to 25% of CAD patients get it. Treatment is focused on improving symptoms. That usually starts with medication.
If medications don’t improve your symptoms, you may be a candidate for a catheter-based procedure.
Catheter-Based Treatment
Catheter-based treatment is a special form of angioplasty. During angioplasty, your doctor puts a catheter (a small, flexible tube) into your artery. The catheter brings special tools to the blockage to open it. We’re one of the few hospitals treating CTO using this technique, which avoids major surgery with large cuts on your body and a long recovery.
Unlike with bypass surgery, you should be able to return to your normal activities in as little as a week after the procedure. And, this method has an 80-90% success rate. A good candidate for this procedure has a chronically occluded artery that is healthy and open beyond the blockage.
Bypass Surgery
The techniques used to open chronically occluded arteries are challenging. Not everyone is a good candidate for catheter-based treatment. Your arteries may have been completely blocked for a very long time. That can make them difficult to treat with catheter-based procedures. If that's the case, bypass surgery may be best for you.
During bypass surgery, surgeons take a blood vessel from another part of your body. They use it to create a new blood vessel in the area beyond where your artery is blocked. This restores blood flow to that area.
A Patient's Symptoms
Jim Rohan didn't know his shortness of breath meant his life was in danger. Hear Jim talk about his symptoms and getting CTO treatment.
[RUNNING SOUNDS] It took time to become life threatening to me. I did not have a tightness in my chest or things that made me go, oh my god, I'm going to die. I had test results that said, oh my god, you're going to die if you don't take care of this. When I met with my doctor, he was uncomfortable with my family history. I don't smoke, I don't drink, but I've always been overweight. And one of the things I noticed was when I golfed before the procedure, I would get tired around the 14th hole.
I got tired physically from swinging, I got tired with my grip on the clubs, and I just assumed that was because I'm getting older and I'm fat, and that's what happens to everybody. My LAD was totally occluded, totally blocked. And the weight gain was the thing that actually made me think, wow, this is terribly serious and life threatening. That's when it really made me think, I want this thing opened up, I want it fixed.
Anywhere from 20% 30% of patients with coronary disease will have a chronic total occlusion, what that means is that an artery is completely 100% block, and it's been that way for a long time. Chronic total exclusions represent one of the most challenging subsets of patients. In general, the perception is that they're very hard to treat and most cardiologists don't bother, and so that leaves a whole subset of patients, up to 30%, that are inadequately treated or treated not to the optimal degree in terms of their symptom controls.
Just in my career, there's been huge advances and for the first time we're really able to offer patients who previously didn't have great options, new treatments that can really make a difference in their lives.
As concerning as it was-- and it was very concerning, I think my interaction with the doctor and him taking time to explain it really, really helped me prepare for everything that might happen. And my confidence level in him was as high as it gets. It's like 48 minutes.
Yeah, that's fantastic. Jim is just a tremendous success in terms of what we want to achieve with our cardiac patients.
Well, my next visit was at the six month mark. And by then, I had lost exactly 100 pounds.
I like to think that what we did was at least planted the seed and got him started. I almost didn't recognize him, he looked so good and he looked like a new man.
I can't imagine where I would be if I didn't have this procedure done. It's counter-intuitive that something so serious can be treated so easily and successfully. It was completely fixed. And a day and a half later, I'm playing golf. I've started a new chapter in my life, chapter 61. It was my gift to myself, to be able to run 6.1 miles. A mile for every decade when I turned 61 years old. I really didn't think I was ever going to be able to do that again. Dr. Ragosta literally saved my life.
[MUSIC PLAYING]
CTO is common in people with CAD or those who have already had a heart attack. The symptoms of CTO can be similar to other heart and artery problems:
- Chest pain
- Fatigue
- Unable to exercise
Risk factors for getting CTO are the same as for other forms of blockage and include:
- A family history of CAD
- Smoking or other tobacco use
- Diabetes
- High cholesterol
To check you, your doctor may pass a heart catheter through your coronary arteries to check if they are blocked.