Patient Education: chronic total occlusion
Understanding Chronic Total Occlusions (CTO)
What is a chronic total occlusion (CTO)?
A CTO is a coronary artery that has been completely blocked for several months or longer. Blood often reaches the heart muscle through small natural bypass vessels, which is why symptoms can be subtle or progressive rather than sudden and dramatic.

Did You Know? Up to 20% of patients have a CTO identified during coronary angiography, yet many remain untreated despite ongoing symptoms.
Common Symptoms
Symptoms vary and may include:
  • Chest discomfort or tightness
  • Shortness of breath with activity
  • Fatigue or reduced exercise tolerance
  • Depression
  • Symptoms that limit work, daily activities, or enjoyment of life
Some patients are told their symptoms are "manageable" or that nothing more can be done.
That is not always true.
Why Treatment Can Help
For carefully selected patients, treatment can:
  • Reduce or eliminate angina completely
  • Improve exercise capacity and energy levels
  • Restore confidence in daily activities
  • Reduce reliance on multiple medications
  • Improve overall patient wellbeing and happiness
Treatment is not about chasing perfect looking arteries.
It is about helping you live better.

A Patient-First Approach
Not every blockage needs a procedure. Not every patient benefits from intervention. A patient-first approach means understanding how your symptoms affect your life, carefully reviewing scans and test results, discussing all options including medical therapy and procedures, and recommending treatment only when the potential benefit is clear.
Modern Techniques, Thoughtful Care
Advances in imaging and catheter-based techniques now allow many complex blockages to be treated safely and effectively. These procedures require careful planning, experience, and a strong focus on safety. When intervention is recommended, the priority is durable symptom relief with the lowest possible risk.
Your symptoms matter.
Your quality of life matters.
That is always the priority.
© 2026 Dr Primero Ng. All rights reserved.
Consultant Interventional Cardiologist, Perth, Western Australia.
Information on this website is general in nature and does not replace individual medical advice.