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article-100024_0 | Chronic Total Occlusion of the Coronary Artery -- Continuing Education Activity | Chronic total occlusion (CTO) lesions are diagnosed in patients who are undergoing coronary angiography as part of the evaluation of ischemic heart disease, cardiomyopathy, or valvular heart disease. CTO revascularization has not shown benefit in rates of all-cause mortality, myocardial infarction, stroke, and repeat r... | Chronic Total Occlusion of the Coronary Artery -- Continuing Education Activity. Chronic total occlusion (CTO) lesions are diagnosed in patients who are undergoing coronary angiography as part of the evaluation of ischemic heart disease, cardiomyopathy, or valvular heart disease. CTO revascularization has not shown ben... |
article-100024_1 | Chronic Total Occlusion of the Coronary Artery -- Continuing Education Activity | Objectives: Describe the histopathology of a chronic total occlusion (CTO) lesion. Review the risk factors for developing chronic total occlusion (CTO) lesions. Outline the typical presentation of a patient with chronic total occlusion (CTO) lesions. Explain the importance of improving care coordination amongst the int... | Chronic Total Occlusion of the Coronary Artery -- Continuing Education Activity. Objectives: Describe the histopathology of a chronic total occlusion (CTO) lesion. Review the risk factors for developing chronic total occlusion (CTO) lesions. Outline the typical presentation of a patient with chronic total occlusion (CT... |
article-100024_2 | Chronic Total Occlusion of the Coronary Artery -- Introduction | A coronary chronic total occlusion (CTO) is defined as 100% occlusion of a coronary artery for a duration of greater than or equal to 3 months based on angiographic evidence. The TIMI (thrombolysis in myocardial infarction) flow grading system is a scoring classification from 0-3 referring to the levels of coronary blo... | Chronic Total Occlusion of the Coronary Artery -- Introduction. A coronary chronic total occlusion (CTO) is defined as 100% occlusion of a coronary artery for a duration of greater than or equal to 3 months based on angiographic evidence. The TIMI (thrombolysis in myocardial infarction) flow grading system is a scoring... |
article-100024_3 | Chronic Total Occlusion of the Coronary Artery -- Introduction | A "true" CTO is defined as 100% occlusion of a coronary artery with TIMI 0 flow; whereas a "functional" CTO is defined as severely stenotic, yet, less than a 100% occlusion of the coronary artery with TIMI 1 flow for a duration of greater than or equal to 3 months based on angiographic evidence. [2] Moreover, it is dif... | Chronic Total Occlusion of the Coronary Artery -- Introduction. A "true" CTO is defined as 100% occlusion of a coronary artery with TIMI 0 flow; whereas a "functional" CTO is defined as severely stenotic, yet, less than a 100% occlusion of the coronary artery with TIMI 1 flow for a duration of greater than or equal to ... |
article-100024_4 | Chronic Total Occlusion of the Coronary Artery -- Etiology | Risk factors for CTO lesion in patients are as below [3] : Known coronary artery disease or history of myocardial infarction Excessive tobacco use High LDL cholesterol, low HDL cholesterol Diabetes Sedentary lifestyle Hypertension Family history of premature disease End-stage kidney disease Obesity Postmenopausal women | Chronic Total Occlusion of the Coronary Artery -- Etiology. Risk factors for CTO lesion in patients are as below [3] : Known coronary artery disease or history of myocardial infarction Excessive tobacco use High LDL cholesterol, low HDL cholesterol Diabetes Sedentary lifestyle Hypertension Family history of premature d... |
article-100024_5 | Chronic Total Occlusion of the Coronary Artery -- Epidemiology | CTO lesions are found in approximately one-quarter to one-third of patients undergoing diagnostic coronary angiography. The true prevalence, however, in the general population is unknown due to a subset of patients with CTO lesions being asymptomatic or minimally symptomatic and never undergoing diagnostic coronary ang... | Chronic Total Occlusion of the Coronary Artery -- Epidemiology. CTO lesions are found in approximately one-quarter to one-third of patients undergoing diagnostic coronary angiography. The true prevalence, however, in the general population is unknown due to a subset of patients with CTO lesions being asymptomatic or mi... |
article-100024_6 | Chronic Total Occlusion of the Coronary Artery -- Epidemiology | Data from the National Heart, Lung, and Blood Institute (1997–1999) Dynamic Registry showed that CTO lesions are most common in the right coronary artery and least common in the left circumflex artery. Older patients are more likely to have at least one CTO lesion with 37% prevalence in patients under the age of 65 ye... | Chronic Total Occlusion of the Coronary Artery -- Epidemiology. Data from the National Heart, Lung, and Blood Institute (1997–1999) Dynamic Registry showed that CTO lesions are most common in the right coronary artery and least common in the left circumflex artery. Older patients are more likely to have at least one CT... |
article-100024_7 | Chronic Total Occlusion of the Coronary Artery -- Pathophysiology | Pathogenesis of coronary artery disease, which can progress to CTO lesions, has multiple contributing factors, which include upregulation of the immunologic and inflammatory markers (cytokines, leukocytes, high sensitivity C-reactive protein), endothelial dysfunction, and cholesterol accumulation. Most commonly, it st... | Chronic Total Occlusion of the Coronary Artery -- Pathophysiology. Pathogenesis of coronary artery disease, which can progress to CTO lesions, has multiple contributing factors, which include upregulation of the immunologic and inflammatory markers (cytokines, leukocytes, high sensitivity C-reactive protein), endothel... |
article-100024_8 | Chronic Total Occlusion of the Coronary Artery -- Histopathology | Histopathological attributes of a CTO lesion commonly consist of calcium, lipids (both intracellular and extracellular), smooth muscle cells, an extracellular matrix, and neovascularization. Occlusions typically have a dense concentration of collagen-rich fibrous tissue at the proximal and distal ends contributing to a... | Chronic Total Occlusion of the Coronary Artery -- Histopathology. Histopathological attributes of a CTO lesion commonly consist of calcium, lipids (both intracellular and extracellular), smooth muscle cells, an extracellular matrix, and neovascularization. Occlusions typically have a dense concentration of collagen-ric... |
article-100024_9 | Chronic Total Occlusion of the Coronary Artery -- History and Physical | CTO lesions are diagnosed in patients who are undergoing coronary angiography as part of the evaluation of ischemic heart disease, cardiomyopathy, or valvular heart disease. Patients with ischemic heart disease generally present with typical chest pain symptoms (stable or unstable angina), atypical chest pain, NSTEMI, ... | Chronic Total Occlusion of the Coronary Artery -- History and Physical. CTO lesions are diagnosed in patients who are undergoing coronary angiography as part of the evaluation of ischemic heart disease, cardiomyopathy, or valvular heart disease. Patients with ischemic heart disease generally present with typical chest ... |
article-100024_10 | Chronic Total Occlusion of the Coronary Artery -- History and Physical | The history should also include risk factors for cardiovascular disease (diabetes, tobacco abuse, hypertension, hyperlipidemia) and non-cardiac causes of the patient's symptoms, including pulmonary embolism, aortic dissection, pneumothorax, esophageal rupture or perforating peptic ulcer. Physical examination in these p... | Chronic Total Occlusion of the Coronary Artery -- History and Physical. The history should also include risk factors for cardiovascular disease (diabetes, tobacco abuse, hypertension, hyperlipidemia) and non-cardiac causes of the patient's symptoms, including pulmonary embolism, aortic dissection, pneumothorax, esophag... |
article-100024_11 | Chronic Total Occlusion of the Coronary Artery -- Evaluation | A significant component of an assessment for a patient who presents with signs and symptoms of ischemic heart disease is history and physical exam. These should include vital signs (respiratory rate, blood pressure, temperature, and heart rate), review of the patient's medication list, and an electrocardiogram. During ... | Chronic Total Occlusion of the Coronary Artery -- Evaluation. A significant component of an assessment for a patient who presents with signs and symptoms of ischemic heart disease is history and physical exam. These should include vital signs (respiratory rate, blood pressure, temperature, and heart rate), review of th... |
article-100024_12 | Chronic Total Occlusion of the Coronary Artery -- Evaluation | A healthcare provider should consider thyroid function testing, pulmonary function testing, routine blood work, including cardiac enzymes, chest X-ray, and echocardiography as part of their initial evaluation. If the initial assessment and evaluation are performed on an urgent basis, intravenous access should be obtain... | Chronic Total Occlusion of the Coronary Artery -- Evaluation. A healthcare provider should consider thyroid function testing, pulmonary function testing, routine blood work, including cardiac enzymes, chest X-ray, and echocardiography as part of their initial evaluation. If the initial assessment and evaluation are per... |
article-100024_13 | Chronic Total Occlusion of the Coronary Artery -- Treatment / Management | CTO revascularization has not shown to benefit rates of all-cause mortality, myocardial infarction, stroke, or repeat revascularization; however, it has shown to significantly improve patients' quality of life and reduce symptoms of angina. [10] [11] [12] Nuclear medicine stress test or myocardial viability studies are... | Chronic Total Occlusion of the Coronary Artery -- Treatment / Management. CTO revascularization has not shown to benefit rates of all-cause mortality, myocardial infarction, stroke, or repeat revascularization; however, it has shown to significantly improve patients' quality of life and reduce symptoms of angina. [10] ... |
article-100024_14 | Chronic Total Occlusion of the Coronary Artery -- Treatment / Management | In patients who meet the indication for a CTO PCI, informed consent is necessary before the procedure after an extensive discussion about the risks and benefits of CTO PCI for the patient. Due to the challenging nature of the CTO lesions, a successful outcome for PCI in these lesions is when the procedure obtains TIMI-... | Chronic Total Occlusion of the Coronary Artery -- Treatment / Management. In patients who meet the indication for a CTO PCI, informed consent is necessary before the procedure after an extensive discussion about the risks and benefits of CTO PCI for the patient. Due to the challenging nature of the CTO lesions, a succe... |
article-100024_15 | Chronic Total Occlusion of the Coronary Artery -- Treatment / Management | Multiple scoring systems are available to operators to predict technical success in CTO lesions. One of the most commonly used scoring systems is the J-CTO score, developed using the Chronic Total Occlusion Registry in Japan. A J-CTO score is used to predict the probability of crossing the CTO lesion within 30 minutes,... | Chronic Total Occlusion of the Coronary Artery -- Treatment / Management. Multiple scoring systems are available to operators to predict technical success in CTO lesions. One of the most commonly used scoring systems is the J-CTO score, developed using the Chronic Total Occlusion Registry in Japan. A J-CTO score is use... |
article-100024_16 | Chronic Total Occlusion of the Coronary Artery -- Treatment / Management | Another commonly used score to predict the technical success of CTO PCI is the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) score. This predictor uses four independent factors to assess the CTO lesion, which includes CTO lesion proximal cap ambiguity, moderate/severe ... | Chronic Total Occlusion of the Coronary Artery -- Treatment / Management. Another commonly used score to predict the technical success of CTO PCI is the Prospective Global Registry for the Study of Chronic Total Occlusion Intervention (PROGRESS-CTO) score. This predictor uses four independent factors to assess the CTO ... |
article-100024_17 | Chronic Total Occlusion of the Coronary Artery -- Differential Diagnosis | STEMI NSTEMI Pulmonary embolism Aortic dissection Pneumothorax Esophageal rupture Perforating peptic ulcer disease | Chronic Total Occlusion of the Coronary Artery -- Differential Diagnosis. STEMI NSTEMI Pulmonary embolism Aortic dissection Pneumothorax Esophageal rupture Perforating peptic ulcer disease |
article-100024_18 | Chronic Total Occlusion of the Coronary Artery -- Prognosis | In addition to causing symptoms, CTOs have correlations with a worse overall prognosis, with higher rates of death and non-fatal adverse cardiovascular events in several populations. Patients with CTOs tend to be older and have more comorbidities and more significant impairment of left ventricular function. Furthermore... | Chronic Total Occlusion of the Coronary Artery -- Prognosis. In addition to causing symptoms, CTOs have correlations with a worse overall prognosis, with higher rates of death and non-fatal adverse cardiovascular events in several populations. Patients with CTOs tend to be older and have more comorbidities and more sig... |
article-100024_19 | Chronic Total Occlusion of the Coronary Artery -- Complications | Percutaneous coronary intervention (PCI) of a CTO lesion on average requires more fluoroscopy time, higher contrast volume, and carries a lower success rate compared to non-CTO PCI’s. CTO PCIs also have a higher complication rate than non-CTO PCIs with major complications, including myocardial infarction, stroke, vesse... | Chronic Total Occlusion of the Coronary Artery -- Complications. Percutaneous coronary intervention (PCI) of a CTO lesion on average requires more fluoroscopy time, higher contrast volume, and carries a lower success rate compared to non-CTO PCI’s. CTO PCIs also have a higher complication rate than non-CTO PCIs with ma... |
article-100024_20 | Chronic Total Occlusion of the Coronary Artery -- Complications | Data analysis of the National Cardiovascular Data Registry-Cath PCI Registry in the United States showed higher in-hospital major adverse cardiovascular event frequency (1.6 versus 0.8 percent; p<0.001) which included mortality (0.4 % versus 0.3%; p<0.001), stroke (0.1% versus 0.1 %; p = 0.045), tamponade (0.3% versus ... | Chronic Total Occlusion of the Coronary Artery -- Complications. Data analysis of the National Cardiovascular Data Registry-Cath PCI Registry in the United States showed higher in-hospital major adverse cardiovascular event frequency (1.6 versus 0.8 percent; p<0.001) which included mortality (0.4 % versus 0.3%; p<0.001... |
article-100024_21 | Chronic Total Occlusion of the Coronary Artery -- Complications | Another multicenter registry (OPEN-CTO) from 12 CTO-PCI centers of 1,000 consecutive patients undergoing CTO PCI evaluated success rates, complication rates, and health status benefits at one month. CTO PCIs showed a success rate of 86%, with an in-hospital mortality of 0.9%, 1-month mortality of 1.3%. 4.8% of the pat... | Chronic Total Occlusion of the Coronary Artery -- Complications. Another multicenter registry (OPEN-CTO) from 12 CTO-PCI centers of 1,000 consecutive patients undergoing CTO PCI evaluated success rates, complication rates, and health status benefits at one month. CTO PCIs showed a success rate of 86%, with an in-hospi... |
article-100024_22 | Chronic Total Occlusion of the Coronary Artery -- Deterrence and Patient Education | Patient education should include resources such as videos and pamphlets. Teaching should focus on risk factor reduction and lifestyle modification such as smoking cessation, blood pressure management based on guidelines, screening for new-onset diabetes, and exercise as tolerated. | Chronic Total Occlusion of the Coronary Artery -- Deterrence and Patient Education. Patient education should include resources such as videos and pamphlets. Teaching should focus on risk factor reduction and lifestyle modification such as smoking cessation, blood pressure management based on guidelines, screening for n... |
article-100024_23 | Chronic Total Occlusion of the Coronary Artery -- Enhancing Healthcare Team Outcomes | Educating patients at risk for coronary artery disease and making a closed-loop communication between them and their cardiologist for primary and secondary prevention can further improve the management of patients at risk of these CTO lesions. Collaboration with shared decision making (between primary care physician, c... | Chronic Total Occlusion of the Coronary Artery -- Enhancing Healthcare Team Outcomes. Educating patients at risk for coronary artery disease and making a closed-loop communication between them and their cardiologist for primary and secondary prevention can further improve the management of patients at risk of these CTO... |
article-100024_24 | Chronic Total Occlusion of the Coronary Artery -- Enhancing Healthcare Team Outcomes | The interprofessional team care provided to the patient must use an integrated care pathway combined with an evidence-based approach to evaluating CTO lesions. The earlier angiographic and demographic predictors of failure to revascularize are identified in CTO lesions; the better is the prognosis and outcome. | Chronic Total Occlusion of the Coronary Artery -- Enhancing Healthcare Team Outcomes. The interprofessional team care provided to the patient must use an integrated care pathway combined with an evidence-based approach to evaluating CTO lesions. The earlier angiographic and demographic predictors of failure to revascul... |
article-100024_25 | Chronic Total Occlusion of the Coronary Artery -- Review Questions | Access free multiple choice questions on this topic. Comment on this article. | Chronic Total Occlusion of the Coronary Artery -- Review Questions. Access free multiple choice questions on this topic. Comment on this article. |
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