Chronic Total Occlusions (CTO) Procedure

Tallahassee Memorial is the only center in North Florida and South Georgia offering percutaneous coronary intervention (PCI) for chronic total occlusions (CTO), a minimally invasive alternative for patients with completely blocked arteries that are not candidates for bypass surgery. 

Approved by the Food and Drug Administration (FDA) in 2011, the procedure involves using new technology and techniques to bypass blockages by entering the wall of an artery and using stents to create a new tunnel for blood to flow out the other side. Arteries in the wrist or groin are used to access the heart, so the chest is never opened.

PCI for CTOs is the most complex type of angioplasty performed. Offering it requires highly skilled cardiologists and lab technicians, as well as commitment to advanced training. Our interventional cardiologists have more than 30 years of combined experience in angioplasties and have undergone countless hours of training through online lectures, live case studies and on-site training sessions with pioneers in the field. 

Who qualifies for chronic total occlusion treatments?

Candidates who may be eligible for minimally invasive treatment of their CTO include:

  • Patients with 100 percent blockages of their coronary artery and severe symptoms  (such as angina) who are not candidates for bypass surgery.
  • Patients who have already had bypass surgery and have an artery that has reclosed. 
  • Patients with a CTO in only on artery who otherwise have healthy arteries. 

The goal is to get rid of a patient’s angina, remove them off any medications they may be taking to manage their CTO and return them to living an active lifestyle. 

What symptoms are commonly associated with a chronic total occlusion? 

Because CTOs normally form slowly over time, the heart often develops small channels around a blockage call “collaterals” to reroute blood to the heart. Collaterals allow the heart to get enough blood to prevent a heart attack but are not equipped to carry the full supply that the original artery did. This often results in angina – or chest pain. 

Patients with severe angina as a result of a CTO experience chest pain whenever they exert energy, making simple activities such as walking the dog, checking the mail, gardening and playing with children difficult. Often, these patients’ quality of life is dramatically affected, and they become deconditioned due to a lack of physical activity. 

Other less common symptoms including weakened heart muscles and ventricular tachycardia – frequent fainting spells. With successful treatment of the CTO, patients can expect symptoms to reside, if not fully disappear. 

What are the advantages of the minimally invasive approach? 

Relief of symptoms and removal off medications are the main advantages. Before technology evolved to make PCI of CTOs possible, patients with CTOs that were too hard to pass through were often forced to live with severe angina and take lifelong medications, because they had no other option. 

Because the CTO is being repaired through arteries in the groin, patients don’t have to have their chest opened, resulting in a significantly shorter recovery time than that of bypass surgery. Patients can expect to go home the day after their procedure if no complications arise and return back to their daily activities fairly quickly. 

Thanks to the increased blood flow, many notice improvement right away.