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CTO: Chronic Total Occlusion

    What is CTO?

    CTO is a pinnacle heart procedure where the artery is completely blocked, it prevents blood from flowing to the part of the heart supplied by that artery. Without enough blood flow, the heart doesn’t receive oxygen and nutrients that need to function properly, resulting in angina. Patients with CTO will develop an alternative circulation to heart, which is referred to as collateral circulation. However, this collateral won’t provide sufficient flow to the heart muscle (myocardium). CTO is commonly found in patients with coronary artery disease. 25-10 % of patients with coronary artery disease also have chronically blocked artery.

    Risk Factors for CTO include:

    • Smoking
    • High Cholesterol
    • Diabetes
    • High blood pressure
    • Obesity

    Symptoms of CTO:

    • Chest Pain
    • Shortness in breath
    • Dizziness
    • Fatigue
    • Nausea
    • Pain in the arm
    • Irregular heartbeat


    CTO treatment focuses on reducing the risk of future heart-related events and improving symptoms. Previously patients who suffer from CTO symptoms were only limited to medication or coronary artery bypass graft (CABG). CABG is an open-heart surgery in which vein or artery is taken from another part of the body and is used to create a new path for blood to flow.

    Nowadays, CTO is treated through a less invasive technique called Percutaneous Coronary Intervention (PCI). Interventional cardiologists use specialized equipment and advance techniques for placing a small mesh tube in narrow or blocked arteries to widen and support the walls of arteries and restore normal blood flow.

    CTO’s can be heavily calcified or extremely fibrotic and the treatment of such lesions is considered to be highly challenging with a success rate of 80-85%.

    Benefits of CTO PCI

    Some possible benefits of CTO PCI are:

    • Improvement in symptoms
    • Improvement in left ventricular function
    • Improvement in survival

    How is CTO PCI performed?

    This procedure is similar to an angiogram and cardiac catheterization. You will be asked to lie on a narrow table in the catheterization room, X-ray camera is used to take pictures.

    CTO procedures are carried out using two entry sites (wrist and groin or both groins). This allows doctors to position two catheters up to your heart so that the vessel can be visualized before and after occlusion. The blockage can be targeted from the front and back (antegrade and retrograde)

    The doctor will use a wire in the coronary artery for creating a passage through the blockage. Once it takes the position then he can use balloon inflations and stents to widen the artery.

    By the end of the procedure, the leg artery is closed using an angioseal. If angioseal can’t be used then a special pressure belt will be used called femostop. If the wrist artery is used, a pressure band is placed around the wrist and will be kept for 2-3 hours.

    Risks of the procedure

    • Bleeding from the artery
    • Transient kidney damage
    • Heart attack
    • Stroke
    • Radiation exposure

    Recent CTO case done by our Doctor in Medicover Hospitals

    Dr. P. Venkata Ramana, a veterinary doctor in Kurnool was told by doctors of various hospitals that he should travel to Japan to get the CTO intervention done to treat his condition. Later a doctor recommended him to Dr. Sharath Reddy, Sr. Consultant Interventional Cardiologist in Medicover Hospitals. Today Dr. Venkata Ramana has completely recovered and is all praises for the treatment provided by Dr. Sharath Reddy. He thanked Dr. Sharath Reddy, his team, and Medicover Hospitals for the advanced technology and expertise available in Medicover Hospitals. Watch the below video to know more: