What Does Coronary Angiography CTO Mean?
Coronary CTO refers to chronic complete occlusion of the coronary artery, with a duration of more than three months. It is a severe type of coronary heart disease. Confirmed by coronary angiography, due to the long occlusion time, the lesions within the blood vessels become hard, accompanied by vascular tortuosity, calcification, etc. CTO lesions all have collateral circulation, which allows a certain blood flow supply to the occluded vessels, but it is only equivalent to the blood flow supply of a 90% narrowed vessel, which can only maintain the survival of the myocardium in a resting state. When the myocardial oxygen consumption increases, patients will develop symptoms of myocardial ischemia such as angina pectoris and decreased exercise tolerance. Successfully opening CTO lesions can relieve patients' angina symptoms, improve myocardial blood supply, and stabilize myocardial electrical activity. Currently, coronary intervention is still the preferred treatment, but due to the complexity of vascular lesions, the success rate of interventional treatment varies from hospital to hospital, and the incidence of complications is relatively high.
The diagnostic purposes of coronary angiography include: 1. Chest pain of unknown origin that cannot be confirmed by noninvasive tests and is clinically suspected to be coronary heart disease. 2. Arrhythmia of unknown origin, such as persistent ventricular arrhythmia or newly developed conduction block; sometimes coronary angiography is needed to exclude coronary heart disease. 3. Left ventricular dysfunction of unknown origin, mainly seen in dilated cardiomyopathy or ischemic cardiomyopathy, and the distinction between them often requires coronary angiography. 4. Recurrent angina pectoris after percutaneous coronary intervention (PCI) or coronary bypass surgery. 5. Before major surgeries such as congenital heart disease and valvular disease, patients over 50 years old are prone to have coronary artery malformations or atherosclerosis, and intervention can be performed during the surgery. 6.asymptomatic but suspected coronary heart disease in high-risk occupations such as pilots, drivers, police, athletes, and firefighters, or for medical insurance purposes.
Typical symptoms of coronary heart disease include chest pain, which is often triggered by physical activities or emotional excitement. Sudden pain in the precordial area is usually described as episodic angina or pressing pain, and can also manifest as a sensation of suffocation. The pain starts from behind the sternum or in the precordial area and radiates upward to the left shoulder, arm, and even the little and ring fingers. The pain can be relieved by resting or taking nitroglycerin. The area of chest pain radiation can also involve the neck, jaw, teeth, abdomen, etc. Chest pain can also occur in a quiet state or at night, caused by coronary spasm, also known as variant angina. If there are changes in the nature of chest pain, such as newly developed progressive chest pain, gradual decrease in pain threshold, to the extent that even slight physical activity, emotional excitement, or even rest or sleep can trigger it. Gradual increase in pain intensity, frequency, and duration, which cannot be relieved by removing the trigger or taking nitroglycerin, often suggests unstable angina.
