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Treatments Heart & Vascular

Chronic Total Occlusion

The goal of treating CTO is to restore blood flow through the coronary arteries and relieve symptoms. Appropriate treatment depends on how much the condition is affecting the heart – and consequently, the patient.

If you aren't experiencing discomfort or symptoms, we may recommend managing your condition through medications, such as drugs that lower cholesterol or blood pressure. But if symptoms develop, or if your condition is already advanced, we offer two procedures:

  • Coronary artery bypass grafting (CABG). In this open-heart surgical procedure, the surgeon takes a section of healthy artery or vein from elsewhere in your body and grafts (connects) it to the blocked artery. One end is attached above the CTO and one end below, providing a way for blood to bypass the blockage. After CABG surgery, patients typically spend one to two days in intensive care and another three to five days in the hospital before going home. Generally, it takes six to 12 weeks to fully recover.
  • Percutaneous coronary intervention (PCI). This minimally invasive procedure to open blocked arteries is performed by an interventional cardiologist. With the patient under sedation (rather than general anesthesia), the doctor makes a small incision in the wrist or upper leg and – guided by imaging – threads a catheter carrying a tiny balloon and a stent (a mesh tube) through blood vessels until it reaches the CTO. Special instruments conveyed by the catheter are used to break up or push through the blockage. The balloon is then inflated to compress the plaque against the artery walls and the stent is placed to help keep the artery open. Most stents now come coated with timed-release drugs that prevent the growth of scar tissue, helping to ensure good blood flow and reduce the need for further treatment. The procedure takes three to six hours, depending on the degree of difficulty in reaching and removing the particular CTO.

Patients usually spend one night in the hospital for observation after PCI. Most experience immediate relief from symptoms and are able to resume normal activity within a few days. A follow-up visit will be scheduled for 14 to 30 days after the procedure.

Seeking care at UCSF Health

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    UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.