Chronic Total Occlusion (CTO)

A chronic total occlusion (CTO) is a complete blockage in one of your heart’s arteries. Our team offers advanced, minimally invasive care to relieve symptoms and lower your risk of future heart problems.

Chronic total occlusion happens when a heart artery becomes fully blocked for at least three months, reducing blood flow to the heart. It can cause chest pain, fatigue or shortness of breath and increase your risk of heart attack over time.

At MU Health Care, our interventional cardiologists specialize in diagnosing and treating CTO. We use advanced imaging and minimally invasive techniques, including complex percutaneous coronary intervention (PCI), to safely restore blood flow to the heart and relieve symptoms.

Whether you’re newly diagnosed, exploring treatment options, managing ongoing symptoms or need a second opinion, we’re here to help.

Our Approach to Chronic Total Occlusion Care

CTO is one of the most advanced forms of coronary artery disease and it requires specialized expertise.

At MU Health Care, our interventional cardiology, cardiac surgery and imaging specialists work together to guide your diagnosis, treatment and recovery. Our team approach allows us to offer the full range of options, from medication and lifestyle support to advanced procedures and surgery.

Chronic Total Occlusion Symptoms

Everyone’s symptoms can feel different. In some cases, there may be no noticeable signs until the condition worsens.

Chronic total occlusion symptoms often appear during physical activity but can also happen at rest. They may include:

Arrythmia (irregular heartbeat)
Chest pain or pressure
Dizziness
Fatigue
Nausea
Shortness of breath
Upper arm pain

When to Call Your Doctor

Call 911 right away if you have chest pain that lasts for more than a few minutes, sudden shortness of breath at rest or other signs of a heart attack such as dizziness, nausea or sweating.

If you’ve noticed new or worsening symptoms like fatigue, chest discomfort or reduced exercise tolerance, talk with your doctor. The sooner CTO is identified, the more options you may have for treatment.

Chronic Total Occlusion Risk Factors

Several risk factors can raise your risk for CTO, including:

Diabetes
High blood pressure
High cholesterol
Obesity
Prior heart attack
Smoking

If you have any of these risk factors, your doctor may recommend imaging or other tests, especially if you’ve had symptoms or a previous heart issue.

How We Diagnose Chronic Total Occlusion

Accurate diagnosis is key to choosing the right treatment. At MU Health Care, we provide a detailed, efficient evaluation to explain your symptoms and guide next steps.

Our interventional cardiologists and imaging specialists use advanced tools to identify blockages and plan the right approach for you. Whenever possible, we also review outside medical records before your visit to help us understand your needs and make the most of your time.

Depending on your symptoms and history, we may recommend:

Cardiac MRI: A noninvasive scan that uses radio waves and magnets to assess heart movement and blood flow. MU Health Care is the only hospital in mid-Missouri offering cardiac MRI for CTO diagnosis.
Coronary angiogram: A catheter-based test using contrast dye and X-rays that shows where coronary arteries are narrowed or blocked.
Echocardiogram: Ultrasound images assess valve function and heart pumping ability.
Electrocardiogram (EKG/ECG): Measures electrical activity in your heart to detect irregular rhythms or prior damage.
PET scan: Uses a tracer dye to highlight areas of reduced blood flow in the heart, helping guide diagnosis and treatment.
Stress test: Evaluates how your heart performs during activity, such as walking on a treadmill or cycling.

How We Treat Chronic Total Occlusion

Our goal is to restore healthy blood flow and reduce your risk for serious complications such as heart failure or death. We personalize your treatment plan to your symptoms, anatomy and overall health.

Your CTO care team may include interventional cardiologists, cardiac surgeons, imaging experts and anesthesiologists working together to guide you toward the most effective treatment.

Medical Therapy and Risk Management

Medications may help reduce CTO symptoms and slow disease progression. Your plan may include:

Angiotensin receptor blockers (ARBs): Help manage blood pressure and reduce strain on your heart.
Aspirin: Prevents blood clots in narrowed arteries.
Beta-blockers, ACE inhibitors and calcium channel blockers: Control blood pressure and protect heart function.
Nitrates: Relieve angina (chest pain) by widening blood vessels.
Statins and other cholesterol medications: Lower cholesterol and reduce plaque buildup.

We also focus on lifestyle support, including help managing diabetes, weight, smoking cessation and stress.

Minimally Invasive Procedures for CTO

If your artery is fully blocked and causing symptoms, your interventional cardiologist may recommend a catheter-based procedure performed through a small incision (often in the wrist or groin).

Options include:

Impella® heart pump support: Used during certain high-risk procedures to maintain circulation and protect the heart.
Percutaneous coronary intervention (PCI): Opens a blocked artery and places a stent to keep it open.
Advanced CTO PCI: Specialized techniques designed to safely cross and treat complete blockages in complex or high-risk cases.
Investment PCI: A partial opening procedure that lets the artery heal, with a stent put in a few weeks later.

Our team has experience treating patients who were previously told they were not candidates for PCI, using advanced tools and techniques to minimize risk.

Surgical Treatment

If PCI isn’t the best option, our surgeons may recommend coronary artery bypass grafting (CABG) — open-heart surgery that creates a new path around the blockage using a healthy blood vessel.

CABG is often the most durable solution for CTO, especially if you have multiple blockages or other heart conditions.

Whenever possible, we perform surgery in hybrid operating rooms that combine imaging, catheterization and surgical technology in one space.

CTO Second Opinions and Complex Case Expertise

If you’ve been told you’re not a candidate for PCI or bypass surgery, our team can help reassess your options. We have experience treating high-risk chronic total occlusion and using specialized devices to protect the heart during procedures.