We can help with chronic total occlusion (CTO) of the coronary arteries.

Northwestern Medicine Bluhm Cardiovascular Institute provides comprehensive care for patients with a coronary artery chronic total occlusion (CTO). This is the most severe form of coronary artery disease (CAD). We are here to help.


Have you or a family member been diagnosed with a CTO?

Our hearts receive blood through the coronary arteries. These two blood vessels branch down the left and right sides of the heart. They are the only sources of blood to the heart. This means that the heart needs them to work well. Coronary artery disease (CAD) occurs when plaque builds up in the artery walls, which compromises blood flow to the heart. CAD affects about 1.2 million Americans each year, leading to stroke and heart attacks. About one in five CAD patients has a coronary artery chronic total occlusion (CTO). This is the most severe form of CAD.

A CTO is the complete blockage of one or more of the coronary arteries with solid plaque (its density is compared to concrete). In most cases, it has been present for more than three months. Often, blood flow is severely compromised due to the blocked arteries. This causes the remaining arteries to detour blood to the compromised area by forming collaterals, or new arteries. This establishes blood flow to the heart.

Northwestern Medicine Bluhm Cardiovascular Institute offers a multi-disciplinary team of interventional cardiologists, who are experts in diagnosing and treating patients with CTOs. They offer an advanced, minimally invasive approach to treat these patients.

Treatment often includes a minimally invasive procedure, a type of percutaneous coronary intervention (PCI). This reduces or removes the blockages in the coronary arteries.

During the CTO procedure, interventional cardiologists enter the patient’s body through a vessel near the groin or wrist. They use tiny wires (or catheters) and other minimally invasive tools to approach the CTO blockages. Standard PCI involves passing the wire through each blockage. But, CTO treatment involves guiding these wires and tools through microscopic layers of the arterial wall and around the blockage.

Once the wires and tools are in place, your healthcare provider will use standard PCI techniques. They will inflate a balloon to displace the plaque. Then, they will add a stent (small mesh tube) to help keep the artery open. This normalizes blood flow.

CTO treatment is more involved and complex than standard PCI, but the procedure is still minimally invasive. In fact, patients often go home the next day. After the procedure, patients’ symptoms tend to improve.

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Make an Appointment

Whether you are experiencing symptoms that you do not understand or have already been diagnosed with CTO and are looking for a second opinion, Northwestern Medicine Bluhm Cardiovascular Institute offers comprehensive expertise to you and your loved ones at multiple convenient locations. 

Bluhm Cardiovascular Institute at Northwestern Memorial Hospital
675 N. Saint Clair Street
Galter Pavilion, Suite 19-100
Chicago, IL 60611
312.NM.HEART (312.664.3278) (TTY:711)

Bluhm Cardiovascular Institute at
Lake Forest Hospital 

1000 North Westmoreland Road
Main Entrance
Lake Forest, IL 60045
847.53.HEART (847.534.3278) (TTY:711)

Northwestern Memorial Hospital is ranked No. 8 in the U.S. for cardiology and heart surgery by U.S. News & World Report, 2022-2023. Our ranking is a reflection of the leading-edge services we offer and the results we achieve for our patients.

  • Highest ranked cardiology and heart surgery program in Illinois for 15 consecutive years
  • Highest available cardiology and heart surgery patient survival score since the metric was introduced
Northwestern Memorial Hospital 312.NM.HEART (312.664.3278)Lake Forest Hospital 847.53.HEART (847.534.3278)


USNWR Best Hospitals, Cardiology 2022-23
McHenry Hospital 815.759.8070

Bluhm Cardiovascular Institute at McHenry Hospital
4201 Medical Center Drive
McHenry, IL 60050
815.759.8070 (TTY:711)

Before PCI

After PCI

Before PCI

After PCI

How is a CTO treated?

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Northwestern Medicine CTO Featured Publications

  1. Nikolakopoulos I, Vemmou E, Karacsonyi J, Alaswad K, Karmpaliotis D, Abi Rafeh N, Schimmel D, Benzuly K, Flaherty JD, Brilakis ES. 2022. Percutaneous coronary intervention of chronic total occlusions involving a bifurcation: Insights from the PROGRESS-CTO registry. Hellenic J Cardiol. 66:80-83. doi: 10.1016/j.hjc.2022.02.005.
  2. Yarusi BB, Jagadeesan VS, Hussain S, Jivan A, Tesch A, Flaherty JD, Schimmel DR, Benzuly KH. 2022. Combined Coronary Orbital Atherectomy and Intravascular Lithotripsy for the Treatment of Severely Calcified Coronary Stenoses: The First Case Series. J Invasive Cardiol. 34(3):E210-E217.
  3. Yarusi BB, Jagadeesan VS, Jivan A, Unger ED, Van Assche LMR, Provias TS, Flaherty JD, Benzuly KH, Schimmel DR. 2021. The Utility of Peripheral Intravascular Lithotripsy in Calcific Coronary Artery Disease: A Case Series. J Invasive Cardiol. 33(4):E245-E251.
  4. Kostantinis S, Simsek B, Karacsonyi J, Alaswad K, Krestyaninov O, Khelimskii D, Schimmel DR, Brilakis E. 2022. In-hospital outcomes and temporal trends of percutaneous coronary interventions for chronic total occlusion. EuroIntervention. doi: 10.4244/EIJ-D-22-00599.
  5. Kostantinis S, Simsek B, Karacsonyi J, Davies RE, Benton S, Nicholson W, Schimmel DR, Brilakis ES. 2022. Intravascular lithotripsy in chronic total occlusion percutaneous coronary intervention: Insights from the PROGRESS-CTO registry. Catheter Cardiovasc Interv. 100(4):512-519. doi: 10.1002/ccd.30354.
  6. Use of Mechanical Circulatory Support in Chronic Total Occlusion Percutaneous Coronary Intervention.
    Karacsonyi J, Deffenbacher K, Benzuly KH, Flaherty JD, Alaswad K, Basir M, Megaly MS, Jaffer F, Doshi D, Poommipanit P, Khatri J, Patel M, Riley R, Sheikh A, Wollmuth JR, Korngold E, Uretsky BF, Yeh RW, Chandwaney RH, Elguindy AM, Tammam K, AbiRafeh N, Schmidt CW, Okeson B, Kostantinis S, Simsek B, Rangan BV, Brilakis ES, Schimmel DR.Am J Cardiol. 2023 Feb 15;189:76-85. doi: 10.1016/j.amjcard.2022.10.049. Epub 2022 Dec 10.PMID: 36512989

Meet the Team

Northwestern Medicine Bluhm Cardiovascular Institute is a nationally recognized destination for those who require highly specialized heart and vascular care.

Bluhm Cardiovascular Institute at
Central DuPage Hospital

25 North Winfield Road
Winfield, Illinois 60190
630.938.3734 (TTY:711)

Bluhm Cardiovascular Institute at Northwestern Palos Hospital
12251 South 80th Avenue, Suite 1520
Palos Heights, Illinois 60463
708.923.4200 (TTY:711)

Central DuPage Hospital 630.232.0280Palos Hospital 708.923.4200