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Interventional Cardiology Outcomes for Chronic Total Occlusions Improve Using advanced technology and specialized training, UCLA interventional cardiologists are improving outcomes of percutaneous coronary intervention for patients with chronic total occlusions of the coronary vessels. Ravi Dave, MD, director of interventional cardiology at UCLA, explains how a small number of centers are taking advantage of the new technology to advance treatment for a challenging problem. STORY HIGHLIGHTS Advanced technology and training enables interventional cardiologists to improve outcomes of percutaneous coronary intervention for patients with chronic total occlusions. New technology has increased success rate for reopening CTOs from less than 50 percent nationally to more than 85 percent at UCLA. What is meant by a chronic total occlusion of the coronary arteries, and how do CTOs develop? How commonly are CTOs discovered on a coronary angiogram, and what is the urgency of treating them? CTOs are 100-percent obstructions of coronary arteries that have been present for more than three months. Typically, there is no downstream blood f low from the main lumen of the artery. They tend to develop in one of two ways. It can be as a silent heart attack, in which the patient experienced symptoms but didn’t seek care, or the symptoms were so weak that he or she didn’t realize what was happening and only later it was discovered on an angiogram. The other way of developing a CTO is that a blockage progresses over time — going from 70 to 80 to 90 to 100 percent. When it gets to that point, the patient may or may not have any symptoms. In 10-to-20 percent of angiograms, patients have no blockages at all — the stress test was falsely positive or it turns out their symptoms are unrelated to the heart. Patients with blocked arteries undergoing a coronary angiogram have up to a one-third incidence of having a CTO. In terms of the urgency, some studies have shown that if you leave the CTOs untreated, these patients can have more damage to the heart muscle, potentially leading to congestive heart failure and a higher three-year mortality. On the other hand, successfully reopening a CTO in the presence of a viable heart muscle has been associated with improvement in symptoms, left ventricular function and survival. Ravi Dave, MD UCLAHEALTH.ORG 1-844-4UCLADR (1-844-482-5237)