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CARE AND TREATMENT
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Chronic Total Occlusion of the
Coronary Arteries
Coronary Artery Disease
Coronary artery disease (CAD) affects the arteries of the heart.
(Figure 1). CAD occurs when the arteries become clogged with
plaque. Plaque consists of fat, cholesterol, and calcium that
collect in the arteries. As plaque builds up, the wall of the artery
becomes rough, hard, and narrowed over time. This is known as
atherosclerosis and decreases blood flow to the heart muscle.
If the blood flow is decreased, the heart muscle does not get the
oxygen and nutrients it needs to function at its best. This can
cause damage to the heart muscle. CAD is the leading cause of
death in the United States.
Figure 1: Coronary Arteries
Left Main
Coronary Artery
Circumflex
Coronary Artery
Right Coronary
Artery
Left Anterior
Descending
Coronary Artery
©2016. The StayWell Company, LLC.
Chronic Total Occlusion (CTO)
When the artery has been completely, 100% blocked for more than 3 months, it is called
chronic total occlusion (CTO).
Figure 2: Atherosclerosis
Chronic Total Occlusion
Normal
Artery
Plaque
Sometimes, when a coronary artery is completely blocked, smaller arteries in the heart
detour blood around the blockage. These new arteries are called collateral arteries. They
bring some, but not enough, blood flow to the affected area of the heart. So, a patient
with CTO can still have symptoms of poor blood supply to the heart, such as:
■ Shortness of breath
■ Fatigue
■ Angina with physical activity
The CTO plaque is often a very thick and hard blockage. These blockages may be difficult
to treat with medications and other procedures. However, the Center for Coronary
Disease at the Northwestern Bluhm Cardiovascular Institute offers advanced techniques
to treat and ease symptoms of CTO.
Treatment Options for Chronic Total Occlusion
First, CTO is diagnosed by an angiogram. This shows the condition of the coronary
arteries. Then, the CTO team will work with you to develop a plan to manage your CTO.
The team includes doctors, nurses, and technicians.
Typically, the first step in this plan is to assess and adjust your medications to improve
symptoms. If this fails, a Percutaneous Coronary Intervention (PCI) especially for CTO is
often recommended.
PCI for CTO can successfully treat and ease symptoms. It can open blockages and
increase blood flow to the heart. Unlike other PCIs in which a wire is passed through a
narrow opening in the artery, a PCI for CTO passes the wires directly through or around
the blockage, often using the collateral arteries that have been formed.
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During the procedure, the doctor inserts a catheter into a blood vessel near the groin
and/or wrist. The special wires or devices are then passed through the catheter to the
blockage.
Once the wires are in place, a balloon is inflated to compress the plaque and open the
artery, and a stent (small mesh tube) is added to help keep the artery open. This allows
blood to flow normally to the heart.
Benefits of Treatment
PCI for CTO can be performed safely by our specially trained staff and the risk of
complications is low. The procedure is minimally invasive and patients often return home
the following day. Afterwards, the improved blood supply and heart function often result
in a dramatic reduction of symptoms.
Who Qualifies for Treatment?
You may be a candidate for this treatment if you have the following:
■ CTO with symptoms from the blocked artery and
■ an abnormal stress test and
■ continue to have symptoms despite medication therapy
Contact Us
For more information about treatment of Chronic Total Occlusion (CTO), please call the
Bluhm Cardiovascular Institute at 312.NM.HEART (664.3278).
Clinical Trials
For more information regarding clinical trials related to coronary disease, please call
312.926.4000.
Northwestern Medicine – Health Information Resources
For more information, contact Northwestern Memorial Hospital’s Alberto Culver Health Learning
Center (HLC) at [email protected], or by calling 312.926.5465. You may also visit the HLC on the 3rd floor,
Galter Pavilion at 251 E. Huron St., Chicago, IL. Health information professionals can help you find the
information you need and provide you with personal support at no charge.
For more information about Northwestern Medicine, please visit our website at nm.org.
Para asistencia en español, por favor llamar al Departamento de Representantes para Pacientes al 312.926.3112.
The entities that come together as Northwestern Medicine are committed to representing the communities we serve, fostering a culture of inclusion, delivering
culturally competent care, providing access to treatment and programs in a nondiscriminatory manner and eliminating healthcare disparities. For questions, please
call either Northwestern Memorial Hospital’s Patient Representatives Department at 312.926.3112, TDD/TTY 312.926.6363, the Northwestern Lake Forest Patient
Relations manager at 847.535.8282 and/or the Northwestern Medical Group Patient Representatives Department at 312.695.1100, TDD/TTY 312.926.6363.
Developed by: NMH Bluhm Cardiovascular Institute
©October 2016 Northwestern Memorial HealthCare
900316 (10/16) Chronic Total Occlusion of the Coronary Arteries