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A minimally-invasive method for opening up blocked arteries would be Percutaneous Coronary Intervention (PCI, previously called as angioplasty with stent).
In PCI, a catheter (a thin flexible tube) is inserted by cardiologists through the inguinal femoral (groin) artery or radial (wrist) artery up via the blood vessels until the site of blockage is reached. The catheter threading is guided to the blockage by employing X-ray imaging. After reaching the blockage site, inflation of the balloon is done to widen the artery for blood to flow steadily. Typically, to keep the artery open, a stent is placed near the site.

 I was told my blockage cannot be opened by angioplasty

While coronary artery bypass grafting is usually the primarily employed procedure for open-heart surgery in the traditional approach to treating CTO, advanced technologies and newer techniques have offered minimally invasive alternatives.

Experienced interventional cardiologists who have received specialised training perform the procedure for advanced methods used in treating CTO without the need to conduct open-heart surgery.

During PCI, tunnelling through the complete blockage can be achieved by employing specialty catheters and advanced wires. The procedure typically needs “creative paths” in order to get through the blockage.

Such creative routes involve ‘employing the artery wall in order to go around the blockage or employing the newly created collateral vessels in order to reach the blockage from behind’.

Then, by employing a technique known as angioplasty, a small balloon is placed within the blockage and then inflated in order to allow pushing the blockage aside. This procedure, followed by stenting, enables a wider opening within the arteries in order to allow normal blood flow. With the recent advances, success rates at the hands of experts have increased to >90%.
If a doctor tells you that you have a complete blockage or a 100% blockage, and that nothing could be done or you would be needing a bypass surgery procedure, then please note that less invasive options are also available (namely CTO PCI).


My blockage has natural bypasses created from the other side. Does it still need to be opened?

A quick answer would be ‘it depends.’ It is not necessary that every blockage has to be opened up. However, should you experience symptoms of blockage like shortness of breath, chest pain, fatigue, particularly when these symptoms become exertional and/or should there be a large portion of the heart muscle is not getting ample blood flow even though it is alive, then it is advisable to open up the blockage.

This underlies a clinical situation that needs a complete evaluation by a cardiologist who knows well about the indications pertaining to a CTO PCI and is also capable of executing the task at a world-class level.

Chronic total occlusions are characterised by 100% blocking of the arteries due to formation of plaque. These arteries can get also remain blocked for several months. The most common is the coronary CTOs, occurring 30% of patients who have significant coronary artery disease.

Additional CTO Statistics

This condition can be treated by following two procedures: bypass surgery or a minimally-invasive procedure carried out in the cath lab.

Atherosclerosis due to the formation of plaque or fatty deposits within the arteries results in a CTO. Atherosclerosis leads to blockage of the artery or arteries supplying blood to the heart.

Symptoms usually develop with worsening of the blockage. CTO is a condition in which the artery is blocked completely (100 percent blockage).
Usually, patients start developing symptoms on narrowing of the artery due to a blockage (70% or more). In most cases, these could be easily treated via stents. However, in the case of a CTO, the artery is blocked completely (100%) and placing a stent would be difficult.

Earlier, patients who had chronic total occlusions (CTOs wherein arteries are blocked 100% for >90 days) had to undergo invasive bypass surgery or restrict themselves with limited activity.

The body usually gets adapted with there is a complete blockage, which makes the heart compensate by forming ‘natural’ bypasses or collateral blood vessels near the blockage. While this could mitigate any damage caused to the heart due to blockage, the collateral blood flow may not be sufficient to keep a check on symptoms.

It is quite crucial that you feel at ease and establish an understanding with the doctor. In its absence, it would be almost impossible to forge a patient-doctor bond.

Furthermore, it is vital to comprehend the cardiologist’s qualifications. Each cardiologist has a different domain of specialisation. Aspects to take into account when choosing the cardiologist to carry out the procedure should include his/her experience of the doctor, number of procedures carried out, level of competence, rate of success, and procedural complications.

It is crucial to have these kinds of discussions with your doctor. Remember that from a doctor’s perspective, it is a distinction and an honour that you have decided to have yourself or your family member taken care of by the medic.