If you have coronary chronic total occlusion (CTO), it means you have coronary artery disease that has completely blocked one of your heart arteries for more than three months.
Overview
The blockage is caused by atherosclerosis, a build-up of fatty deposits and plaque on the inner walls of the artery. This restricts blood flow to your heart and prevents it from functioning properly. As a result, you may experience shortness of breath or chest pain, especially when exercising. To unblock the artery, interventional cardiologists will insert a balloon catheter or a stent.
Our approach
M Health Fairview interventional cardiologists are among the few willing to tackle difficult, high-risk percutaneous coronary interventions to unblock coronary chronic total occlusions.
Before the procedure is performed, you will undergo a cardiac MRI or nuclear stress test to ensure that your heart muscle is still alive. Then our cardiologists will insert a small wire with a balloon at the end to open your artery. A drug-eluting stent will most likely be inserted to keep the artery open after the procedure.
Improved techniques, special guidewires and drug-eluting stents have improved the success rates of CTO treatment. If we can’t get through the center of an artery and open it with a balloon or stent, we may thread a wire between layers of the artery (subintimal pathways) and re-enter the center of the artery when the vessel reconstitutes itself. We also are able to enter the vessel from the reverse angle.
The plaque is hardest at the top of the artery, so if we can’t go through from a forward, or antegrade, approach we enter from the back, or retrograde, and move the wire through collateral branches to enter the blocked artery. In some cases a critical artery may require intervention or your heart function may be too low to tolerate the special instrumentation needed for CTO angioplasty. In these cases, you may be placed on a left ventricular assist device or use extracorporeal membrane oxygenation (ECMO) during the procedure.
We have remarkable success with chronic total occlusion angioplasty therapy, but for those patients who do not respond well, we may perform coronary artery bypass surgery either via the standard surgical approach or using a more minimally invasive robotic surgical procedure. These procedures re-route the flow of blood around the blocked artery by using a blood vessel from another part of your body and connecting it to a healthy artery in your heart.
