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Chronic Total Occlusion (CTO) is a severe form of coronary artery disease, which is defined as the full blockage of a coronary artery for three months or more. The obstruction is usually caused by a slow build-up of cholesterol-rich plaque and scar tissue that stops blood from flowing normally to part of the heart muscle. Over time, the body may form small collateral blood capillaries to somewhat compensate for the decreased circulation, but such vessels often cannot supply enough oxygen during physical exercise.

Many individuals with CTO have symptoms that include ongoing chest pain (angina), shortness of breath, exhaustion, diminished ability to exercise, and pain with exertion. Some may have very few symptoms, making the issue difficult to diagnose until specialized cardiac testing is conducted. Diagnosis is usually made via electrocardiography (ECG), stress testing, echocardiography, coronary CT angiography, and coronary angiography to determine the location and severity of the blockage.

Treatment varies with the severity of symptoms and overall cardiac function. Medications may help ease symptoms and minimize cardiovascular risk, while lifestyle modifications such as stopping smoking, eating a heart-healthy diet, maintaining a healthy weight, and exercising under medical care improve long-term heart health. In appropriate patients, revascularization with complex percutaneous coronary intervention (CTO-PCI) or coronary artery bypass grafting (CABG) may be indicated to improve myocardial perfusion, quality of life, and minimize subsequent cardiac events.