Coronary artery disease is not an uncommon disease and is regarded as one of the leading causes of mortality. It occurs when fats deposit on the walls of the coronary arteries, blood vessels that supply to the heart. It is known as total occlusion when the artery gets blocked completely and not narrowed down. If the occlusion lasts over three months, it is chronic total occlusion. People with chronic total occlusion may experience chest pain, shortness of breath, and fatigue. They are at increased risk of developing heart attacks and other serious heart problems.
Chronic total occlusion is typical and can be found in 15-30% people who undergo coronary angiography. Angiography is a test that assesses the blood flow through the arteries. The heart is a muscle that needs continuous sup[ply of oxygen-rich blood to stay healthy. Coronary arteries supply this oxygen-rich blood. In people with coronary artery disease, plaque develops slowly on the walls of the arteries, thus restricting blood flow to the heart. If enough plaque builds up in the artery, it can completely occlude it. Furthermore, plaques can suddenly block the artery when a blood clot is formed, leading to coronary syndrome or heart attack.
The risk factors associated with chronic total occlusion are:
- Having coronary artery disease or a previous episode of heart attack
- Smoking
- High blood pressure
- High blood cholesterol
- High sugar levels
- Sedentary lifestyle
- Obesity
- Family history of heart disease
The symptoms of chronic total occlusion include chest pain, shortness of breath with activity, and fatigue. A diagnosis of chronic total occlusion is made after a healthcare provider reviews the medical history, conducts a physical examination, and performs one or more diagnostic tests. The ultimate diagnosis of chronic total occlusion is made through coronary angiography.
Coronary angiography involves inserting a thin, flexible tube called a catheter into an artery in the wrist or groin. The wire is guided through a blood vessel into the heart. A contrast is injected through the catheter into the heart's blood vessels, and then X-rays are taken. Using a contrast helps the doctor identify the blockage site and see the blood flow in the vessels. Even when an artery is completely blocked, collaterals grow towards the blocked artery to maintain blood flow to the affected heart region.
Additional tests may be prescribed to confirm the diagnosis. These include an echocardiogram, a stress test, and a magnetic resonance imaging scan to evaluate the heart's overall function and assess the likelihood of a successful procedure. A stress test includes taking an electrocardiogram of the heart under stress, usually during exercise such as walking on a treadmill or riding a bicycle. The various treatment modalities that help in treating the condition are:
Coronary artery bypass graft
Coronary artery bypass surgery graft creates a bypass around the blocked or narrowed artery to restore the blood supply to the heart. A bypass graft can be created using an artery or vein from the patient's body. Blood vessels are retrieved using an endoscope which helps in removing the vessel with a 1-inch precision. Retrieving a vessel is minimally invasive and causes less pain, faster healing, and reduced chances of infection.
Angioplasty
Angioplasty is a minimally invasive procedure to open the blocked arteries. A trained interventional cardiologist usually performs this procedure. The patient is sedated, and an incision is made on the wrist or leg. A catheter carrying a tiny balloon and a stent is passed through the blood vessels until it reaches the occlusion site. Special instruments can be used to break up or push through the blockage. The balloon is then inflated to compress the plaque against the artery's walls, and a stent is placed to keep the vessel open. In recent times, the stents have been coated with drugs that prevent the growth of scar tissue, thus improving the blood flow and reducing the need for further treatment. The procedure takes around 3–5 hours. Patients usually spend one night at the hospital and are discharged the next day. The symptoms improve drastically after undergoing an angioplasty, and a person can resume regular activity in a few days.
FAQs
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Can one survive with chronic total occlusion?
Chronic total occlusion is a life-threatening condition that deprives the heart of oxygen. Without proper treatment, it can reduce the quality of life and cause severe conditions like heart failure.
Can a clogged artery clear itself completely?
The artery can't get rid of the plague without surgery. However, one can prevent further build-up of plague. No food items can clear the arteries naturally. A healthy diet can reduce the chances of developing a clogged artery in the first place.
Can one lead a regular life after undergoing angioplasty?
One can return to work within a week if one undergoes planned angioplasty. But if one is undergoing an emergency angioplasty, especially after a heart attack, the recovery time increases. One may take weeks to months to recover completely.
What is the best stent for chronic total occlusion?
Drug-eluting stents are preferable for angioplasty in chronic total occlusion. These stents reduce the chances of restenosis compared to bare metal stents.
What happens when an artery is completely blocked?
When an artery is completely blocked, collaterals develop around the site of the blockage. Although collaterals cannot wholly compensate for the total supply of the heart, they can reduce symptoms like chest pain and shortness of breath.
What are the risks associated with angioplasty?
Angioplasty can cause death, myocardial infarction, stroke, perforation, pericardial tamponade, coronary dissection, bleeding, contrast-induced nephropathy, or injury to the vessel wall.
Can an electrocardiogram detect a blocked artery?
An electrocardiogram can recognize the signs of blocked arteries, but an accurate diagnosis can only be made with a CT coronary angiography. CT angiogram accurately describes the sites of blockage that can lead to heart attack.
How can one strengthen his heart after undergoing angioplasty?
Here are a few tips to strengthen the heart after undergoing angioplasty:
- Consume more whole grains every day.
- Eat more fruits and vegetables.
- Reduce intake of salt and sugar.
- Cut down the intake of fatty food items.
- Avoid the consumption of red meat.
Advanced Technology & Facilities
At Aster Hospitals, we provide state-of-the-art services to patients. Not only are patients given the best treatment, but they are diagnosed accurately using the latest technologies. Furthermore, at Aster, we believe in being equipped with the latest technology so that our doctors can make precise diagnoses. The various amenities that are available for diagnosis of chronic total occlusion are:
Coronary angiogram
A coronary angiogram is considered the most essential tool for confirming the diagnosis of chronic total occlusion. It precisely locates the site of occlusion.
Electrocardiogram
Electrocardiograms may be done on patients to assess the heart's overall function by recording the electrical signals generated in the heart.
Echocardiogram
To assess the blood flow through the heart, an echocardiogram is done. It helps diagnose certain conditions involving the heart's valves, muscles, and blood flow.
Cardiac stress test
A cardiac stress test evaluates how the heart functions at the time the patient is active. It assesses whether an adequate amount of blood reaches the heart. At Aster, we provide the best treatment options available for treating chronic total occlusion.
Coronary artery bypass surgery
In this surgery, an alternative pathway is created, bypassing the blocked area, to restore blood supply to the heart. The graft can be obtained from blood vessels of the groin or arms.
Percutaneous coronary intervention
Percutaneous coronary intervention is a minimally invasive method in which the blocked arteries are kept patent by passing a catheter with a balloon attached to it. The balloon is inflated at the site of obstruction, and a stent is placed to maintain the patency of the blocked artery.
