CTO PCI or bypass surgery: which is right for you?
When a coronary artery is completely blocked (a chronic total occlusion, or CTO), there are three options: medication alone, reopening the artery with PCI (a catheter procedure), or bypass surgery. The right choice depends on your symptoms, how many arteries are affected, how well your heart pumps and your overall health.
By Dr Primero Ng, MBBS (Hons), FRACP, FACC, FSCAIReviewed October 2026
Chest pain now? If chest discomfort is severe, getting worse, or has lasted 10 minutes, call 000 immediately.
Quick comparison
Medication alone
CTO PCI
Bypass surgery (CABG)
How it's done
Tablets
A catheter procedure through the wrist or groin
Open-chest surgery
Usually suited to
Few or no symptoms
A CTO causing angina despite medication
Several blocked arteries, especially with diabetes or a weakened heart
Main aim
Control symptoms and risk factors
Relieve angina and improve quality of life
Relieve symptoms and, in selected people with several blocked arteries, help them live longer
Recovery
n/a
Usually days
Usually 6–12 weeks
What the evidence shows
Opening a CTO mainly relieves symptoms such as angina and breathlessness. It hasn't been shown to prevent heart attacks or help people live longer.
Guidelines support CTO PCI for people whose angina continues despite medication, or who have a large area of heart muscle short of blood supply because of the blocked artery.
When several arteries are blocked, especially in people with diabetes, bypass surgery generally gives better long-term results than stents.
In experienced centres, CTO PCI succeeds in about 85–90% of cases. Serious complications occur in about 2–3%.
Questions to ask your cardiologist
Are my symptoms caused by this blocked artery?
Is the heart muscle beyond the blockage still alive (viability)?
How many arteries are involved, and would surgery treat them all?
What are my realistic chances of success, and the risks, in my case?
