A Chronic Total Occlusion is a coronary artery that has been completely blocked — with zero blood flow — for at least three months. Unlike a partial blockage, a CTO has fully scarred over with fibrous and often calcified tissue. The body grows collateral vessels to partially compensate, which is why many CTO patients live with the blockage for years before it is detected.
No. CTO PCI requires specialised crossing strategies — antegrade wiring, antegrade dissection re-entry (ADR), and retrograde technique — that are completely different from standard angioplasty. It typically takes 2–4 hours compared to 30–60 minutes for standard PCI, requires specialised equipment, dual arterial access, and an operator with specific CTO training and high procedural volume. It is widely considered the most technically demanding form of coronary intervention.
Dr. Arun Kalyanasundaram is among the most experienced and internationally recognised CTO PCI specialists in India. He has performed over 2,500 CTO PCI procedures across the United States and India. He trained at the Cleveland Clinic — ranked the No. 1 hospital for heart care in the United States for 30 consecutive years (1995–2024) by U.S. News & World Report. He holds triple ABIM certification, is the India Director of the Asia-Pacific CTO Club, published the world-first K14 Stingray CART CTO technique (bearing his name), and is faculty at every major interventional cardiology meeting globally.
Yes, in most cases. CTO PCI is a catheter-based procedure performed through small punctures in the wrist or groin — no open surgery, no general anaesthesia. In experienced hands at high-volume CTO programmes, the technical success rate is 85–95%. The key variable is an operator trained in all three crossing strategies so that if one approach does not work, others can be attempted in the same session. Learn about CTO PCI →
Many patients have chronic stable angina — chest pain or tightness on exertion present for months or years. Some have breathlessness on exertion from reduced left ventricular function. Some have no symptoms at all if collateral vessels are well-developed. CTOs are sometimes discovered incidentally during angiography for another reason.
1–2 nights in hospital. Access site care for a few days. Light activities within a week. Full activity within 2–4 weeks. Dual antiplatelet therapy (aspirin plus clopidogrel or ticagrelor) for 12 months. Follow-up at 4–6 weeks and repeat echocardiogram at 3–6 months.
Yes, absolutely. A second opinion is a recognised and widely recommended step in complex medical decision-making. International cardiac guidelines explicitly endorse second opinions before irreversible treatment decisions such as bypass surgery. A second opinion either validates your current cardiologist's recommendation — giving you confidence to proceed — or offers an alternative perspective you can discuss openly. You are not obligated to change your treating physician.
Cases where patients have been told nothing can be done are exactly the cases where a specialist second opinion is most valuable. A proportion of CTOs considered untreatable at lower-volume centres can be opened at a dedicated CTO programme using retrograde technique or ADR. Patients considered too high-risk for standard intervention may be candidates for CHIP PCI with haemodynamic support. The second opinion gives you an honest assessment of whether treatment is genuinely not possible or whether a different specialist would change that answer.
Please share all relevant medical reports as clear scanned copies. For Coronary Angiogram (CAG), a soft copy of the CD in proper digital format is mandatory — avoid mobile-recorded videos. Send angiogram videos via WeTransfer or as an MP4 file. Minimum required: (1) CAG report/CD, (2) Echocardiogram — latest, (3) ECG — most recent, (4) TMT/stress test, (5) Previous OP notes and clinical history, (6) Lab investigations — cardiac enzymes, electrolytes, CBC, RFT.
INR 3,000 for patients in India. USD 50 for international patients. Follow-up calls to discuss the report are included at no additional charge.
Written report within 2–3 business days of receiving all required documents. Urgent cases are prioritised — indicate urgency when contacting the team.
Chief of Cardiology at Promed Hospital, Chennai. Address: 1/10A East Coast Road, Kottivakkam, Chennai, Tamil Nadu 600041. Phone: 094807 94807. Email: director@ctomd.com.
Dr. Kalyanasundaram holds triple board certification from the American Board of Internal Medicine — Internal Medicine (2005), Cardiovascular Disease (2009), and Interventional Cardiology (2010). He is a Fellow of the American College of Cardiology (FACC) and Fellow of the Society for Cardiovascular Angiography and Interventions (FSCAI). He trained at the Cleveland Clinic Foundation — ranked No. 1 for heart care in the US for 30 consecutive years. He is India Director of the Asia-Pacific CTO Club — the standard-setting body for CTO intervention across South and Southeast Asia.
Over 2,500 CTO PCI procedures across his career in the United States and India. This places him among a very small global cohort of operators who have independently performed more than 1,000 CTO PCI procedures — one of the very few based in Asia.
The K14 Stingray CART technique is a novel CTO PCI innovation developed and published by Dr. Arun Kalyanasundaram in Catheterization and Cardiovascular Interventions in 2023 (PMID: 36617386). It solves a specific failure mode in the Stingray re-entry step of antegrade dissection re-entry. K14 stands for Kalyanasundaram — his nickname from fellowship days at the Cleveland Clinic. The technique has been adopted internationally. It is one of the few CTO innovations worldwide to bear its author's name.
Yes. Patients advised to undergo bypass surgery for complex coronary artery disease may benefit from a second opinion, particularly when chronic total occlusions (CTOs) or high-risk coronary blockages are involved. An experienced CTO PCI specialist can review your angiogram and determine whether a minimally invasive catheter-based procedure may be a suitable alternative.
A 100% blocked artery, also known as a Chronic Total Occlusion (CTO), occurs when a coronary artery is completely blocked and blood flow through that artery has stopped. Many patients can still have symptoms such as chest pain, breathlessness, or reduced exercise capacity despite the development of collateral circulation.
Yes. Many chronic total occlusions can be successfully treated using advanced CTO PCI techniques. Success depends on the location, length, complexity, and age of the blockage, as well as the experience of the treating specialist.
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