Chronic total occlusion

Chronic Total Occlusion (CTO) is a coronary artery disease characterized by a heavy atherosclerotic plaque build-up within the coronary arteries, leading to a complete obstruction of blood flow for at least three months. This condition is a complex and challenging form of coronary artery disease that is often associated with a poor prognosis and a high risk of myocardial infarction or heart attack.

Definition

A Chronic Total Occlusion is defined as a coronary obstruction that prevents any blood flow to a section of the heart for three months or longer. The obstruction is typically caused by a build-up of atherosclerotic plaque, which hardens over time and completely blocks the artery.

Epidemiology

CTOs are found in approximately 15-30% of patients with significant coronary artery disease. They are more common in older patients, males, and those with a history of myocardial infarction, diabetes, or peripheral vascular disease.

Pathophysiology

The pathophysiology of CTO is complex and involves the accumulation of atherosclerotic plaque within the coronary arteries. This plaque hardens over time, leading to a complete obstruction of the artery. The lack of blood flow to the heart muscle can result in ischemia, or insufficient oxygen supply to the heart, which can lead to symptoms such as chest pain or angina.

Diagnosis

The diagnosis of CTO is typically made through coronary angiography, a procedure that uses X-ray imaging to visualize the coronary arteries. Other diagnostic tests may include electrocardiogram (ECG), stress testing, and cardiac MRI.

Treatment

The treatment of CTO is challenging and depends on the patient's symptoms, overall health, and the location and extent of the occlusion. Treatment options may include medication therapy, percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG).

Prognosis

The prognosis for patients with CTO is variable and depends on several factors, including the patient's overall health, the extent of the occlusion, and the success of treatment. However, with appropriate treatment, many patients can experience significant improvements in symptoms and quality of life.