Coronary Artery Chronic Total Occlusion

If you have a Coronary Artery Chronic Total Occlusion and your condition is limiting the quality of your life, there are options. The interventional cardiologists at CHI Health Creighton University Medical Center - Bergan Mercy and Nebraska Heart are using new technology to enable heart patients to regain good health and become active again. Before now, patients who suffered from chronic total occlusions–(CTOs in which arteries are 100 percent blocked for more than 90 days)–had to face invasive bypass surgery or resign themselves to limited activity.

Percutaneous Coronary Intervention

Percutaneous Coronary Intervention (PCI, formerly known as angioplasty with stent) is a new, minimally-invasive technique to open blocked arteries.

In PCI, cardiologists insert a catheter (a thin flexible tube) from the inguinal femoral (groin) artery or radial (wrist) artery up through blood vessels until it reaches the site of blockage. X-ray imaging is used to guide the catheter threading to the blockage. Once it has reached the blockage site, the balloon is inflated to open the artery, allowing blood to flow. A stent is usually placed at the site to keep the artery open.

The physicians on the medical staff at CHI Health Creighton University Medical Center - Bergan Mercy and Nebraska Heart are using state of the art technology and a hybrid approach to treat patients with coronary chronic total occlusion (CTO), complete or almost complete blockage of a coronary artery for 90 or more days.

Coronary CTOs are very common, occurring in as many as 30 percent of patients with significant coronary artery disease.

Additional CTO Statistics

  • 15-30% of all positive heart catheterizations have CTOs
  • In recent years success rate of a CTO procedure has increased from 50% to 90%
  • 1/3 patients with coronary artery disease have CTO
  • The team led by Dr. Agarwal in Omaha has performed 200 CTO procedures in the past 3 years

Coronary Artery Chronic Total Occlusion Symptoms

  • Chest pain
  • Pain in the upper body and arms, possibly concentrated on the left side
  • Jaw pain
  • Indigestion or choking feeling
  • Nausea
  • Dizziness or light-headedness
  • Cold sweat
  • Rapid or irregular heartbeat
  • Unusual fatigue
  • Shortness of breath
  • Swelling in the feet 

Patients may be at increased risk for coronary CTO if they:

  • Smoke or have daily exposure to second-hand smoke, at home or at work
  • Past heart attack or known coronary artery disease
  • Family history of heart disease
  • High cholesterol
  • Postmenopausal status (women)
  • Taking birth control pills and smoking (women)
  • Overweight
  • Diabetes
  • Hypertension (high blood pressure)
  • A sedentary or inactive lifestyle
  • Congestive Heart Failure

Treating CTO

Historically, patients with coronary CTO have been treated with medical therapy or through coronary artery bypass graft (CABG) rather than percutaneous coronary intervention (PCI). However, research has shown that patients with coronary CTO who receive PCI have experienced symptom relief almost immediately and increased chances of survival. 


The technology used in stents also has changed. CHI Health cardiologists are leading the way with a new FDA-approved SYNERGY coronary stent.

The SYNERGY stent is the first and only bio-absorbable polymer drug-eluting stent in the U.S., which means it slowly releases medication so scar tissue doesn’t grow in the artery lining. The stent helps promote good blood flow and faster healing. Patients also are able to stop using blood thinners sooner. And since the polymer coating disappears, the risk of complications such as vessel re-narrowing and blood clots is reduced.

For more information about Percutaneous Coronary Intervention and the SYNERGY stent, please call (402) 398-5654 in Omaha or (402) 450-2586 in Lincoln.