Chronic Total Occlusion (CTO)

Need Advanced Cardiac Care in Orange County? Nobody Knows Hearts Like Hoag.

Coronary artery disease, including Chronic Total Occlusion (CTO) is the leading cause of death in the United States. Every day, the world-class specialists at Hoag’s Jeffrey M. Carlton Heart & Vascular Institute are breaking important new ground in cardiac care in Orange County and beyond. From the state-of-the-art Nancy & Bill Thompson Heart Valve Center and Elaine & Robert Matranga Aortic Center, to our next-generation programs for diagnosing and treating conditions like arrhythmia, severe coronary artery disease and CTO, Hoag’s commitment to the latest and most advanced treatment options and personalized, compassionate care is at the foundation to everything we do.

That commitment is why U.S. News & World Report rated Hoag among the best hospitals in the nation for Heart Bypass Surgery, Heart Attack, Aortic Valve Surgery, Heart Failure and Transcatheter Aortic Valve Replacement (TAVR) for 2023-2024.

When everything is on the line, you need a trusted partner guiding your healthcare journey. Send a message to our subspecialized treatment team at Hoag today.

What is Chronic Total Occlusion (CTO)?

Chronic total occlusion (CTO) is a medical condition involving the complete blockage of one or more of the heart’s coronary arteries for three months or longer. The coronary arteries are the large blood vessels on the surface of the heart that feed the heart muscle with oxygenated blood.

What Causes Chronic Total Occlusion (CTO)?

The coronary blockages that cause chronic total occlusion (CTO) are usually due to the accumulation of a fatty substance called plaque — a waxy blend of fat, calcium, cellular waste and cholesterol — on the walls of the coronary arteries, which are the large blood vessels on the surface of the heart that supply the heart muscle with oxygen-rich blood.

Buildup of plaque in the coronary blood vessels can lead to a condition called coronary artery disease (CAD). Coronary artery disease is the most common form of heart disease, and the leading cause of death in the U.S.

As plaque accumulates, it can begin to narrow or block the coronary arteries, reducing blood flow to that portion of the heart. Sometimes, plaque on the walls of the coronary arteries can “rupture” or break apart. When this happens, a blood clot can form in a blood vessel near the rupture, blocking the blood vessel and blood flow entirely. This is known as “total occlusion.” Chronic total occlusion means the blockage isn’t temporary and has lasted more than three months.

When a total occlusion happens, it can starve the portion of the heart served by the blocked coronary artery of blood flow — a condition known as coronary ischemia. That can cause the heart tissue to die (also known as coronary necrosis), which can lead to what’s known as a myocardial infarction, commonly known as a heart attack.

Tissue death after a heart attack is usually irreversible and can contribute to or cause a range of serious medical issues, including sudden cardiac death. That makes getting the arteries unblocked to restore blood flow as quickly as possible very important.

What are the Symptoms of Chronic Total Occlusion?

The symptoms of chronic total occlusion (CTO) can vary from patient to patient, and depend on the level of blockage, the person’s overall health and other factors. In general, CTO symptoms often include:

  • Chest pain, tightness or discomfort (also known as angina), especially if you experience chest pain while exercising or during periods of emotional stress
  • Shortness of breath (dyspena)
  • Fatigue
  • Nausea
  • Pain in the upper arm
  • Dizziness and fainting
  • Heart palpitations or experiencing abnormal heartbeats (arrhythmia)​​​​​​

Explore screening, diagnosis and treatment options for CTO available at Jeffrey M. Carlton Heart & Vascular Institute.

Who is Most at Risk to Develop Chronic Total Occlusion?

Chronic Total Occlusions are a severe form of coronary artery disease (CAD). It’s estimated that up to one-third of those with CAD have chronic total occlusion. As such, the risk factors for chronic total occlusion are mostly the same as the risk factors for CAD. Risk factors for chronic total occlusion include:

  • Having coronary artery disease (CAD)
  • Being older, as your risk of chronic total occlusion increases as you age
  • Having a family history of cardiac issues, particularly if family members experienced heart problems like a heart attack, heart failure or narrowed or blocked arteries early in life.
  • Leading a sedentary lifestyle, without much physical activity or exercise
  • Having diabetes
  • Having previously had a heart attack
  • Being overweight or obese
  • Smoking tobacco
  • Having uncontrolled or poorly managed high blood pressure (hypertension)
  • Having high cholesterol
  • Eating a diet that’s high in sugar, fats, carbohydrates and cholesterol

Are There Any Ways to Reduce My Risk of Chronic Total Occlusion?

Because chronic total occlusions are a severe progression of atherosclerosis and coronary artery disease, reducing your risk factors for chronic total occlusion involves many of the same techniques utilized in reducing the risk of most heart-related conditions. They include:

  • Eating a heart-healthy diet that’s low in fats, carbohydrates, cholesterol, sugar and salt, with plenty of fruits and vegetables
  • Getting plenty of exercise
  • Seeing your healthcare provider for regular checkups
  • Seeking prompt medical care for conditions like high blood pressure, diabetes, chest pain, shortness of breath, etc.
  • Taking the steps necessary to lower your stress levels
  • Maintaining a healthy weight
  • Taking any prescribed medications exactly as directed and talking to your doctor before starting any over the counter medication or supplement.

Does Chronic Total Occlusion Have You Worried? Find advanced CTO Treatment Options in Orange County at Hoag.

Whether it’s our commitment to next-generation diagnostic options or our groundbreaking work in less-invasive cardiovascular procedures, the heart specialists and experienced cardiologists at Hoag’s Jeffrey M. Carlton Heart & Vascular Institute are leaders in the diagnosis and treatment of conditions involving the vascular system and heart, including chronic total occlusion.

From Hoag’s Heart Rhythm Program that is changing the lives of patients with arrhythmias such as atrial fibrillation, to the Coronary Artery Disease Program, every doctor and specialist at Hoag is ready to work collaboratively to meet the high standard of compassionate, patient-centered cardiac care Orange County deserves.

Find the answers you need at Hoag. Contact us by calling or using our online form to learn more.



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