CTO Revascularization

Chronic Total Occlusion Intervention

An advanced form of PCI to open completely blocked coronary arteries that have been closed for months or years, requiring specialized techniques and expertise.

What is a Chronic Total Occlusion?

A Chronic Total Occlusion (CTO) is a coronary artery that has been completely blocked for at least 3 months. Unlike partial blockages, CTOs represent 100% obstruction of blood flow through the affected artery. The body often develops collateral vessels (natural bypasses) to provide some blood flow to the heart muscle, but these are rarely adequate for optimal heart function.

CTO interventions are among the most technically challenging procedures in interventional cardiology. They require specialized training, equipment, and expertise that Dr. Bleszynski acquired during his interventional fellowship at the University of Rochester.

Why Open a Chronic Total Occlusion?

Opening a CTO can provide significant benefits for patients:

Symptom Relief: Reduction in angina (chest pain), shortness of breath, and fatigue
Improved Heart Function: Restoring blood flow can improve the heart's pumping ability
Better Quality of Life: Increased exercise tolerance and ability to perform daily activities
Potential Survival Benefit: Especially in patients with significant viable heart muscle supplied by the blocked artery
Alternative to Bypass Surgery: May avoid the need for open-heart coronary bypass surgery

Why Are CTOs Challenging?

Hard Cap Formation

The blockage develops hard, calcified tissue that is difficult to cross with standard wires and catheters.

No Road Map

Without blood flow, the path through the blockage cannot be visualized with standard angiography.

Tortuous Course

The artery may curve and twist through the blockage, making navigation difficult.

Length of Occlusion

Longer blockages are more technically demanding and require more time and expertise.

Advanced CTO Techniques

CTO revascularization employs state-of-the-art techniques including:

Antegrade Wire Escalation

Using progressively stiffer wires to cross the blockage from the front

Antegrade Dissection Re-entry (ADR)

Creating a controlled path around the blockage when direct crossing isn't possible

Retrograde Approach

Accessing the blockage from the other side via collateral vessels

Intravascular Imaging

Using IVUS to confirm wire position and optimize stent deployment

Who May Benefit from CTO Revascularization?

CTO intervention may be considered for patients who:

Have symptoms (angina, shortness of breath) despite optimal medical therapy
Have viable heart muscle in the territory supplied by the blocked artery
Have a CTO that is technically feasible to open based on imaging
Are not good candidates for or prefer to avoid bypass surgery
Have incomplete revascularization after previous procedures

Frequently Asked Questions About CTO Revascularization

What is a chronic total occlusion (CTO)?

A chronic total occlusion is a coronary artery that has been completely blocked (100% occluded) for at least 3 months. Unlike partial blockages, CTOs have no blood flow through the blocked segment. The body often develops collateral vessels to supply some blood to the affected heart muscle, but these natural bypasses are usually not adequate for optimal heart function.

Why is CTO intervention more difficult than regular stenting?

CTO procedures are among the most technically challenging in interventional cardiology. The blockage develops hard, calcified scar tissue that is difficult to cross. There is no blood flow to visualize the path through the blockage, and specialized techniques like retrograde approaches through collateral vessels may be required. Success rates improve significantly with specialized training and experience.

What are the benefits of opening a chronic total occlusion?

Opening a CTO can provide significant symptom relief including reduced chest pain, shortness of breath, and fatigue. It may improve heart function and exercise capacity. In some patients, it can provide survival benefits and may offer an alternative to bypass surgery. Quality of life improvements are often substantial.

What is the success rate for CTO procedures?

At experienced centers with CTO-trained operators, success rates are typically 80-90%. Success depends on the complexity of the blockage, including its length, calcification, and anatomy. Some CTOs may require multiple attempts or a staged approach.

Is CTO intervention right for me, or should I have bypass surgery?

The choice between CTO intervention and bypass surgery depends on several factors including the number and location of blockages, your overall health, and preferences. Some patients are better suited for one approach over the other. A heart team discussion involving an interventional cardiologist and cardiac surgeon helps determine the best option for your specific situation.

Specialized Training

Dr. Bleszynski received specialized training in complex coronary interventions during his interventional fellowship at the University of Rochester.

Quick Facts

Procedure Time: 1-4 hours
Anesthesia: Local with sedation
Hospital Stay: Overnight observation
Success Rate: 80-90% at expert centers

Have a Complete Blockage?

If you've been told you have a chronic total occlusion that can't be opened, schedule a consultation for a second opinion.

Schedule Consultation (702) 805-5678