Imagine driving through a tunnel.
On Monday, you encounter a pile of rubble. There is a narrow gap, big enough to drive through.
On Tuesday, you're driving through the tunnel and find a giant boulder blocking the entire tunnel. No gaps whatsoever.
Now translate those examples to your health. The tunnels are the arteries that carry blood to your heart. The rubble and boulders are blockages that can lead to problems – shown through symptoms.
Blocked tunnels aren’t good for traffic flow, and blocked arteries aren’t good for your heart.
In cardiology, the boulder is called a Chronic Total Occlusion (CTO). It means the artery is completely blocked. This occurs in 15% to 20% of patients who have heart disease. Sometimes there has been a complete blockage for many months or even years. However, only about 3% to 5% of these patients undergo a stent or bypass procedure, so there's a real need to help these untreated patients.
Failure to diagnose and treat a CTO can lead to symptoms and impact your quality of life.
Impacts of a complete blockage
Artery blockages are not created equal. Treatment of an artery that is 97% blocked is much easier than treating one that has been 100% blocked for a long time. The symptoms – chest pain, tightness, and shortness of breath – can be similar, though.
Sometimes, when arteries become completely blocked, a new blood supply develops around the blockage. This new blood supply, called collaterals, won't deliver as much blood to your heart. This can lead to those same symptoms of chest pain and shortness of breath.
If you have these symptoms, a stress test can help determine if they are caused by a blockage in an artery or something else. The first step is to see a doctor.
Fifteen years ago, we had one way to treat Chronic Total Occlusions – try to probe a wire through the blockage from the front. These procedures had a 70% to 75% success rate, which kept some doctors from recommending treatment.
Today, we have more treatment options. We can sometimes go around the blockage or work backward through the heart. We're now seeing success rates of 90% to 95%.
If you are told that you have an artery that is 100% blocked, it’s important to know that it can be treated.
Benefits of treatment
Patients should understand that successful treatment will relieve symptoms and will result in a better quality of life. Clinical studies are still under way tracking the long-term outcomes of this type of treatment, but we are seeing very consistent benefits so far.
When you need treatment for a Chronic Total Occlusion, most doctors will refer you to a CTO Center. UT Southwestern is positioned to become a Center of Excellence for CTO treatment.