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Angioplasty, Bypass or Medication?

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Is there a time to stop with recurring angioplasties and go with bypass surgery? When should bypass surgery be done instead of angioplasties?

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Current Postings on This Page (50):

• Confusion in Bangladesh -- You have hit upon a central controversy in cardiology: surgery, stents or medical therapy? One factor is the state of your father's heart post-MI. Is it damaged and, if so, what part? Opening an artery that supplies a dead part of the heart muscle has little or no benefit. As for surgery vs. PCI, there is a score that was devised a few years ago by cardiologists and surgeons. It's called the SYNTAX score, and it can help guide therapy, as to whether surgery or PCI provides more benefit. Additionally, your father's diabetes would probably push doctors in the direction of bypass surgery, although the latest data from studies of the newer generation of stents, specifically the Medtronic Resolute, shows no difference between diabetic and non-diabetic patients (unless they are insulin-dependent diabetics).
Angioplasty.Org Staff, Angioplasty.Org, April 20, 2013

• My father aged 62yrs, weight 60, have diabetic, had a heart attack on last 13 December, 2012. His Angiography report is as follows.LM: NormalLAD: Type III vessel. 80% stenosis at the level of D1 (Medina 111). Diffuse disease in the distal part of LAD. D1 is also diseased.LCX: Dominant. OM2 id large vessel with 60% stenosis at the origin and 100% stenosis in the proximal part. Distal part of OM2 is not visualized.RCA: Nondominant, Diffusely diseasedRenal arteries: NormalDiagnosis: Double vessel disease.Advice: PCI to LAD.We have consulted one cardiac surgeon and he suggested to do 3 (three) by pass surgery. Another doctor suggested to take medicine (no by pass or stenting). Another doctor suggested to do angioplasty with 2 (two) stenting. Now we in a great confusion, what we really have to do. Pls suggest a proper medication for my father.
Confusion on doctor's suggestion, Bangladesh, March 20, 2013

• Shahrukh in Pakistan -- Looking at the information you've communicated, if your father is not feeling well and having chest pains, then you and he really should see his cardiologist. It's really not possible to answer these questions remotely and without all the medical records and expertise of his cardiologist. It would be best to accompany your father to this appointment so there are "four ears and eyes". And make sure to ask his cardiologist these questions so you both understand what the possibilities are and how to proceed.
Angioplasty.Org Staff, Angioplasty.Org, March 6, 2013

• There are not any significant diseases except pain in his chest this might due to chalking (calcified). The by-pass graft is not closed up but something happening to him is very bad.
Shahrukh, student, Karachi, Pakistan, March 4, 2013

• Shahrukh in Pakistan -- Given the new information, it's a bit clearer why his doctors are not keen to do another procedure. Opening up a total occlusion, especially one that is probably old and calcified, is difficult. Not clear is the status of his bypass grafts. Are they also closed up? Finally is the health status of his right coronary artery. Is there significant disease there as well?
Angioplasty.Org Staff, Angioplasty.Org, March 2, 2013

• Your opinion was too good for understanding the criteria but thing i didn't mention you that is my father survives in only one vein i.e. RCA (Right coronary artery) and remaining two are totally occluded i.e. LAD and CX ... Now the problem is that the surgeon and cardiologist both rejected to do any operations CABG or PCI... is this good for him or not? as he feels pain again time by time on his chest and conditions are similar as happened before ......Another question is that how much my father will survive on one Vein and what are risks involve now with his recent condition......thanks.
Shahrukh, student, Karachi, Pakistan, March 1, 2013

• Shahrukh in Pakistan -- We can't tell from your posting the reason why your father's doctor said CABG or another PCI is not an option. Sounds like one (or more) of his bypasses closed up -- in fact ten years is about the duration for a saphenous vein graft. A similar issue occurred, for example, with US President Bill Clinton three years ago, and they put two stents in to open the native artery that had been bypassed. The question is whether the angina (chest pain) is being caused by the stent closing up, or another artery. Some patients still get angina even though there is no narrowing causing reduced blood flow (and oxygen) to the heart. For those patients, there are other options, such as anti-anginal medications like ranolazine, or therapies like EECP.

And to Mubeen in India -- We cannot give medical advice to you in place of a doctor. But we would ask you to make sure to have the opinion of an interventional cardiologist, one who does angioplasty and stenting. If he/she looks at the angiogram and recommends CABG, then that would be the way to go. If not, perhaps the cardiologist and surgeon could discuss your father's case together with you and your father, so you understand the options, possible benefits as well as the risks of either procedure. One question is what are your father's symptoms and what were the results of a functional test (like a nuclear stress test) to show whether he has significant ischemia or not. Is your father's angina stable? Has he gone on a regimen of medication and life-style changes (diet, smoking, exercise)? That is usually the first level of treatment, but again, you need to ask these questions of his doctor(s).
Angioplasty.Org Staff, Angioplasty.Org, February 28, 2013

• My father is 60 years old. He has undergone angiogram test on Feb 2013. The angiogram report is as below
LAD: Type iii vessel ostioproximal
Mid LAD shows long segment 7O to 80% Stenosis
D1 arises from a diseased segment
D2 good sized vessel
LMCA: Normal
LCX : Normal
PDA/PLV : Normal
Cardiologist and surgeon have advised for CABG. Request you to please let me know if this can be cured with medication? If not should we go with CABG or Minimally Invasive CABG treatment?
Mubeen Ahmed, Global Technology centre, Hyderabad, India, February 24, 2013

• My father had a CABG in 2002 and then in July 2012 he had angioplasty (drug eluting stent ) with non ionic-dye. Now the problem arises again as he feels pain in chest and in his back again. Now after meeting with consultant he said that he (my father) will not able to do such treatments like PCI or CABG to retain his normal life. Now what can I do?
Shahrukh, student, Karachi, Pakistan, February 23, 2013

• Angioplasty or Bypass in India -- As you are aware, this is a complication and complex decision. We do not (and cannot) give medical advice on these matters, but would steer you to something called the SYNTAX score, which was designed by a group of interventional cardiologists and surgeons together to determine whether a specific situation involving multivessel and left main disease might be better served via bypass or angioplasty. The results came out in favor of bypass surgery, but a specific decision depends on many factors. If you look at the Syntax calculator you will see that there are many components to take into consideration in creating a SYNTAX score, something that a cardiologist who has your records could do. Also, you've described the anatomy very specifically, but nothing about the patient -- things like general state of health, age, and patient preference all come into play. You might want to consult a surgeon. And should you decide to go for angioplasty, make sure the interventional cardiologist has experience with left main disease and also uses IVUS and/or FFR in the procedure.
Angioplasty.Org Staff, Angioplasty.Org, February 9, 2013

• Left Main: Normal LAD: Type III vessel shows ostial segment 90% stenosis followed by proximal segment 90% stenosis. Mid lad shows 60-70% stenosis. 1st diagonal is large vessel and shows proximal and mid segment non-obstructive plaques. RCA: Dominant vessel, shows proximal segment 90% stenosis. Which is suitable: Angioplasty/ Bypass? We have received advice for both the options by different cardiologists. Kindly suggest.
Angioplasty or Bypass, India, February 9, 2013

• angioplasty is better method for older people if you are younger go for bypass surgery which is a better method.
Nag, Andhrapradesh, India, December 29, 2012

• PTCA from India -- We cannot give medical advice, and certainly not long distance. It's also important to actually see the angiograms and, of course, what your father's clinical symptoms are (pain, breathing, ability to exert himself, etc.) These are very complicated issues and it's easy to be overwhelmed with information and differences of opinion. One question for your cardiologists is about staging the procedures. How many procedures do they plan to do? Which blockages will be addressed first? We can't tell from your description, but it seems as if the LCX, LAD and LADD blockages might be at the bifurcation of those branches, which is a more complicated procedure. An important question would be what is the status of your father's kidneys? With disease, as you have described, it may be that his kidneys are functioning below normal. Contrast dye, used in angiography and angioplasty, is known to affect kidneys -- they need to be functioning normally to clear the contrast. If they are not, the contrast can damage the kidneys -- another reason for staging these procedures. Finally, since you've posted to this topic on "Angioplasty, Bypass or Medication", has bypass surgery for the coronaries (with angioplasty for the renals) been discussed? Hope this helps.
Angioplasty.Org Staff, Angioplasty.Org, April 6, 2012

• My father has CAG and PAG done with following findings. LMCA:Normal LAD: Type III, MID LAD 50% Stenosis, Distal 50% Stenosis Diagonal: D1 medium, Ostial Proximal 70% Stenosis LCX: Non dominant, proximal 99% stenosis, Distal vessel slow filling. RCA: Dominant, Mid RCA 90% Stenosis. LV Angio:PAG: Rt Renal 80% Stenosis, Lt renal 90% Stenosis. Now after visiting 3 to 4 cardiologists. I have got difference of opinions about whether PTCA to be done to both RCA & LCX or only to RCA. all are telling that PTA to be done to both renals. Please advise me.
PTCA to LCX and RCA , India, April 6, 2012

• Ray in Istanbul -- Your post is very detailed and your current doctors are discussing a complex topic. The very proximal part of the LAD is next to what is called the left main branch, historically an area not treated with angioplasty. That has changed and there have been a number of studies presented in the last few years regarding the feasibility of stenting the left main, as well. This has become routine in some centers. That being said, the best opinion of whether or not you are a candidate for stenting or bypass surgery can only be made by a doctor(s) who has access to your complete medical records and your angiogram. There may be several reasons why your cardiologist is recommending CABG instead of stenting. Every patient's anatomical situation is a bit different. Because, as we state in our disclaimer, nothing on this web site should be used as a substitute for consultation with a doctor, if you are concerned, you might want to get a second opinion from an interventional cardiologist in a high volume center who regularly performs left main or proximal LAD stenting, although your current cardiologist may be such a physician. Yours is definitely a complex situation and your current doctor is being cautious, and probably for a good reason. Let the Forum know what happens.
Angioplasty.Org Staff, Angioplasty.Org, April 23, 2011

• I am 50 yr. old male. I had two DES stents inserted in 2004 , one in LAD distal, at a N.Y. hospital. Recently I had an angiogram done at a hospital in Istanbul and during the angiogram doctor found that the DES implanted in LAD distal is 100% blocked and also LAD proximal is 70% blocked. He told me that due to the lesion of the LAD proximal blockage it is very risky to try to implant stent there and the only safest option is to perform a bypass. Blockage is right at the beginning of the LAD. He said trying to implant the stent, we could damage the artery and an emergency operation would be needed. He said if we could implant stent there, we can also unblock the DES stent implanted in 2004. But since we can not enter the 70% blocked artery, we can do none of those. I'd like to know if there is a high risk of inserting a stent in that lesion. I also welcome the comments of patients who had experiences in similar lesion. Thanks. Ray
LAD proximal patient, Istanbul, Turkey, April 23, 2011

• Dear A. Rodriguez in Virginia -- while there have been allegations recently of "over-stenting" and, as in any field, there are outliers who do not follow the guidelines and may be motivated more by financial gain, it is flatly wrong to indict an entire branch of medicine (i.e. interventional cardiology). Stents are an alternative to bypass surgery. Neither are cures for what is a progressive disease. President Clinton had bypass surgery, and five years later two of his bypasses closed up and, guess what...he got two stents! And he is now fine. The profession has developed what's called a SYNTAX score to help determine stents vs. surgery. We certainly agree that patients should consult both a surgeon and a "stent" doctor if they have questions. In many of the larger institutions, this is becoming standard procedure. In any case, we are glad that bypass worked for you and that you have regained your "game". Best to you!
Angioplasty.Org Staff, Angioplasty.Org, March 9, 2011

• After many visits/copays and lots of BS and 7 stents later, and yes the coated stents. I had the quadruple bypass surgery, the best thing I have done. They bypass all the blocked stents and I am back to play tennis and feeling better. My advice to everyone is that Doctors are getting fat$ on the stents, It is now a lucrative thing for Doctors.They are getting paid well and they are getting kickbacks from the Labs. If they can place 20 stents a week they can afford vacations for their family and mistresses. Stent placement is not the solution!!!
A. RODRIGUEZ, Virginia Beach, Virginia, USA, March 9, 2011

• Sonja -- We're not sure what type of doctors you are discussing. It is unfortunate that the ER doc did not pick up on the fact that he may have been having a heart attack. We would recommend getting a consult with both an interventional cardiologist and a cardiac surgeon. Perhaps they could talk to each other to help determine the best course of action for your father. There are some anti-anginal medications, but they won't reduce a blockage.
Angioplasty.Org Staff, Angioplasty.Org, May 15, 2010

• My father is 67 and had a triple bypass ten years ago along with a mechanical valve, now (diabetic) back in feb 2010 he has been having chest pains, and when he eats the food feels like it's not going down..took him to hospital said he was fine and that he had heartburn..so then a month later he's complaining of chest pains and looks very pale and goes to ER again a day later doctor is sending him home telling him he is fine that he has angina. A family doctor sees him and gave him his fourth blood test and noticed that his blood did not have enough enzymes and tells my dad that he had a heart attack. So, he goes to UCSD and they do a angioplasty & put stents has four blocked and can't unplug one artery..now May 2010, a month later complaining of chest pains again and right arm getting numb, goes to see the doctor tells him he is at risk for heart surgery or even a angioplasty to unplug the remaining artery's. Is there anything we can do at this time or does he have to live with this discomfort until he gets a other heart attack..or can a medication be given to him to reduce the blockage if possible...or should we go get a second opinion? My dad is determined to get something done?
Sonja C., California, USA, May 12, 2010

• I am a 56 yr old male and have been in and out of the hospital on a regular basis. In Nov 07 I had an MI and had my first stent placed. In 2008 I was hospitalized 7 times and had no new stents placed. In Mar 09 I had another MI and my stent was blocked so they cleaned it and then placed a stent in the right side as I had blockage. Well anyway I have now 7 stents in the heart area and two stents in my left leg as I have PAD, CAD, AF, COPD and who knows what else. The nurses say I need by-pass and so do my friends who have had it. My doctor even admits that I have had more stents in one year than any person he has assisted. When do I say enough is enough and I want this taken care of so I can stay out of the hospital? In the last year I have been hospitalized 11 times. I am getting tired and my body is getting real tired of this. Usually my EKG's are fine as well as X-rays, but my cardiac markers are always high. My heart rate at rest is usually 90-110 which makes me more tired. Anyone else have similar situations.
Alvin Carle, Lakeside, California, USA, March 17, 2010

• RG -- as we state, we cannot give "medical advice" -- only a qualified cardiologist with access to a patient's complete medical records, angiograms, etc. can do that -- and because each patient's situation differs, what may be correct for one person may be less so for another. Your father has a complex condition: multivessel disease with accompanying co-morbidities (COPD, hypertension, etc.). Some cardiologists in this case may recommend bypass surgery over PCI (stents, angioplasty) as being more successful in the long run, more "durable". Some interventional cardiologists, the ones who do angioplasty, may look at the angiogram and feel they can treat the blockages successfully with stenting, and avoid surgery. (Although, if an interventional cardiologist is the one recommending surgery, then that would be persuasive.) One big consideration would be your father's advanced age and co-morbidities. Bypass surgery (CABG) is a significant open procedure -- what effect would this operation and longer recovery have on your father's clinical condition? Stenting is only minimally more traumatic than the angiogram he's already had -- especially when done radially, from the wrist. Hope this helps.
Angioplasty.Org Staff, Angioplasty.Org, February 2, 2010

• My father is 80 years old. Due to breathlessness was admitted In emergency, diagnosed with COPD, hypertension. LVEF 45 TO 50% ECHO during this however led to angiography. his hemoglobin also dropped by the next day of admission with stool for occult positive. thus angiography was performed from wrist which showed left main: normal , LAD: type 3 vessel Ostial 90%, DIAGONAL-1: PROXIMAL 90% STENOSIS, LEFT CIRCUMFLEX:MID 90% AND in right coronary : Minor plaquing in proximal and 70% in mid segment . Endoscopy thereafter was normal with hemoglobin level raised on each day after it dropped (now around 12), stool for occult is now negative. Gastrologist has however advised colonoscopy . Cardiologist based on above recommends CABG/PTCA in angio report. At present He doesn't have diabetes, though is on sugar control, quit smoking 30 years back and had hotchkins 22 years back and treated. Cardio has advised for 1st option CABG AND NEXT option as two stents. He is active now and is taking med including clopidogrel 75mg daily .When can he have PTCA? What precautions to be taken before PTCA as far as his hemoglobin levels dropping INITIALLY. Will PTCA and stent result in full recovery?
RG, India, February 2, 2010

• Patrick -- Protonix (pantoprazole) has not been shown to increase arterial blockages. There recently has been concern that another Proton Pump Inhibitor (PPI) Prilosec (omeprazole) may reduce the effectiveness of Plavix, but still that's got nothing to do with causing blockages. Possibly your "new" blockages were previously unseen; possibly your disease is advancing. You have multivessel coronary artery disease and there is much debate over whether bypass surgery or stenting is the best treatment. Much of the decision comes down to the specific case, the patient, clinical status, location of blockages, etc. What you can do is to lower your risk factors as much as possible: stop smoking (if you do), exercise, eat a healthy diet and definitely take the prescribed medications, which are very effective these days in lowering cholesterol, etc.
Angioplasty.Org Staff, Angioplasty.Org, October 25, 2009

• March of 2008 I had a heart attack. Two stents were place one in the RCA and one in the OM2. In April of 2009 I had recurring chest pain and shortness of breath. Once again I had 2 stents in the LAD. Now in Sept. of 2009 I had more problems resulting in a stent in the RPDA at a bifurcation. I am still out of breath and feeling pain and a heaviness in my chest. At this point I don't know how many more stents might be placed. Am I a case for CABG? I am on Plavix and asp. among other blood pressure meds. My doctors had me on Protonix from the start. Could this be a source for my problems? Thanks.
Patrick D., Illinois, USA, October 20, 2009

• I just had an angiogram that revealed 3 blocked coronary arteries that could not be stented (70%, 90%, 90%) and CABG was recommended. I am 50, female, diabetic and obese. The treatment the surgeon usually follows is pre-surgery diet to reduce weight. This may not be an option due to insurance running out -- Is there time to find another job (i.e. a 3 month window before surgery in which I can also do lifestyle modifications), or should I go through the surgery now, jobless, and hope that I have a short recovery?
Pat M, San Francisco, California, USA, September 14, 2009

• About 3 months ago, I had a severe acid indigestion. I was getting slight discomfort in my stomach when I walked short distances. Doctors diagnosed it as angina, and as I had very high cholesterol (untreated) they skipped the stress test and sent me to angiogram. The test revealed a 90% narrowing of the circumflex artery. The other coronary arteries are clear. They referred me to elective angioplasty with stenting. I have been on beta blockers and statin since, and I am symptom free. Do I need a stent,or should choose medical treatment. Am I in danger of a heart attack from this particular narrowing if I do not get it done?
Oktay R., London, United Kingdom, September 9, 2009

• KM -- check out our recent blog post which is sort of about this ("Is Radioactive Isotope Shortage an Opportunity for CT Scans to Shine?"). Was he treated with angioplasty or a stent when he had the MI? The question with any test is: how will the results change the course of therapy? Of the two, the CT angiogram is the non-invasive one, where a cardiac cath involves threading a catheter into the artery, musch like an angioplasty, and is invasive.
Angioplasty.Org Staff, Angioplasty.Org, July 31, 2009

• My Father is a 80year old and a month back had a mild MI. he was in the Hospital for a week and later discharged. Later after 15 days he has undergone TMT (Tread Mill Test). Doctor advised he may undergo Angiogram. Then the same reports were shared with two well known Cardio Hospitals. The doctors are of the opinion that the angiogram is not a must and can be done a bit later. Now my family members are pressuring me to do the angiogram or 64 Scan. Now I am confused what to do. Can any specialists can suggest on the same?
KM, Bangalore, India, July 28, 2009

• Subrata -- from your post, we can see that you have a number of issues: COPD, heart failure, hypertension, etc. One clear action you can take is to stop smoking -- cigarettes cause all of the illnesses that you suffer from. It is difficult to stop, but there are many groups that may be able to help. Your doctor also may be able to steer you towards some. Angioplasty is a procedure to alleviate chest pain, or to restore blood flow in critical cases. Whatever good this medical procedure will do may easily be "undone" by continued smoking.
Angioplasty.Org Staff, Angioplasty.Org, January 30, 2009

• I have been suffering from AMI since june 2007. Primarily i continued to feel mild chest pain and considered it as gastric and accordingly took enzyme tabs. The pain was not constant but continued. After 3/4 days i visited the doctor and he instantly said that an attack has already occured on LVF and the present block is 90%. Thereafter I went for angiograph and cardiogram which shows 90% block and LVEF is 35%. Therefrom the the doctor opined for medicine treatment as the case has been presented very late. The doctor also advised that i should not walk more than 10/15 minutes and should refrain from taking any stress. Since then I have been lying almost on the bed and taking medicines as prescribed. Previously i had no problem with heart. Rather i was a COPD patient and was under continuouos treatment of the said doctor for last 10 years and remained well. i was also a smoker and he advised me to get rid of this smoking immediately which i did not follow. My pulse normally remain high (80-115) and was diagonised a patient of hypertension. After more than one year i was released from the hospital after thorough treatment i was under regular check up of the doctor and remained allright. But in the last August2009 one day i went out of breath very suddenly and fell unconscious. immediately i was brought to the hospital and the doctor administrated life saving injection with the help of which i regained breath and became allright/ There was nothing wrong with my heart function. after ecocardiograph LVEF was found 42% and pulse 80. The doctor repeatedly advised me not to take minimum stress and avoid crowded place. I have been following his instructions and now i am again fine. under the circumstances, i woould like receive advises whether angioplasty can help my affected heart at present? or any other valuable advises in order to provide me tension free cured life at this age of 62+. Thank you verymuch.
Subrata Banerjee, retired, Kolkata, West Bengal, India, January 25, 2009

• D.S. -- an "ad hoc" angioplasty is one where the diagnostic catheterization procedure is converted into an intervention (stent or angioplasty) and everything occurs in the same session. This is done when the problem is clear, obvious and is easily fixed in one session. In your case, there was a doctor/patient judgement required. We'llalso bet that you had been given a sedative to relax for the procedure -- something that would it difficult for you to make a decision. Even if you hadn't been sedated, it is hard for a patient to make such a decision on the cath table. A decision about bypass vs. angioplasty for multivessel disease is a complicated one and should be made in a rational way with all the facts in hand, and not in the midst of a procedure. We would encourage you to consult a cardiac surgeon (a doctor who does bypass surgery) as well as other interventional cardiologists (these are not surgeons -- they are the doctors who use catheters to do angioplasty). Stents are definitely used for multiple artery blockages -- but in some cases of diffuse disease, bypass may be the better option.
Angioplasty.Org Staff, Angioplasty.Org, April 30, 2008

• Can anyone help me? I have been diagnosed with 9 blockages in all three main arteries. During angiogram I was asked to decide if I wanted bypass or stents. The surgeons said they could do one stent then and four later. Others would not be able to be fixed unless I did bypass. I am a 53 year old woman and was not ready to make decision. So they did one stent. Now after review I have decided I would rather have bypass. I am having chest pains, pain in back and arm. My cardiologist says I can not do bypass now as I am on plavix and must stay on. It is a drug eluting stent. Is this so? They want to do more stents and I just am not sure I am comfortable with that. Thanks.
D.S., Wisconsin, USA, April 18, 2008

• Dilip -- no "opinion" from the internet, this site included, should be a substitute for medical advice from a medical doctor. As for stents -- FDA approval means that the device has gone through rigorous trials and presentation of data here in the U.S. There are many devices outside the U.S. that never get FDA approval because they never apply for it -- mainly these devices will not be sold in the U.S. anyway. Whether one stent is "better" than another is something you might discuss with your cardiologist. Some stents are better for certain patients or situations, some for others. Your quick description indicates diffuse disease and multiple blockages along with diabetes -- these are all risk factors for restenosis with stents and most cardiologists would strongly consider bypass surgery in such cases, but again -- these are discussions best conducted with your cardiologist so you can intelligently discuss the pros and cons
Angioplasty.Org Staff, Angioplasty.Org, March 17, 2008

• I had a bit of mid-chest pain one day during morning walk, this pain subsided after a few minutes and I could re-walk . This happened for a few days , EGC was normal, I started taking beta blockers, and found that I could walk better, without much discomfort. But I did treadmill test (TMT) showing ST depression about 4.5 mm exercise time about 6.5 minutes .ANGIOGRAPHY showed lad diffusely effected from ostium onwards tightest part showing 90% block, LCX 90% block, RCA diseased, non-dominant. Diabetic, on oral drugs. smoked 15 yrs ago. Will stents do? or do I need A BYPASS? ARE FDA APPROVED STENTS BETTER THAN NON FDA APPROVED STENTS? PLEASE ADVISE.
Dilip, Chittagong, Bangladesh, March 15, 2008

• i am having a problem of deciding whether to go for bypass surgery or angioplasty.. the angiogram was studied by 3 different cardiologists who came to three different conclusions. a) the first doctor advised to go for angioplasty. b) the second doctor said that this is a certain case for bypass. c) the third said that the blockages can be cured by medicine. As a layman what should one do to take the right decision and how to know that the decision will be correct. can anybody help me...
Venkatram Srinivasan, Kolkata, India, February 22, 2008

• Dr. R. -- not clear on your timeline as to when you first had stents. But your question is one that is central to all the research being done on coronary artery disease (CAD). As we've said, angioplasty, stents, even bypass surgery, are not cures for CAD -- they are mechanical solutions to biological problems. However, they do have the ability to "turn the clock back" somewhat in terms of putting off an acute event, perhaps completely. You're certainly doing all the right things vis-a-vis diet and lifestyle. Every week more is being learned about genetic markers, etc. and the hope is that the mechanism that causes these blockages will be discovered and therapies invented. Meanwhile monitoring and, assuming it's possible, stress reduction is very important (an important part of Dean Ornish's therapy is meditation).
Angioplasty.Org Staff, Angioplasty.Org, February 14, 2008

• To keep this topic open and ask the editors for help, please. I had 2 DES in Dec. 07; 1 each in the RCA and circumflex. After one year I stopped the plavix for 5 days and seemed to have a recurrence of the anginal symptoms experienced before the stents. I restarted the plavix but after 5 days of continuing symptoms, called my cardiologist. Next day recathed. The stents were wide open BUT 2 new 90+ % blockages in the same arteries (and a 60+ % blockage in the LAD); ALL NEW! 2 more DES in the RCA and Circumflex Any thoughts on what has caused the rapid progression of my disease? I have NO co-morbidity , had no MI before the stents, have exercised regularly for pretty much my entire life (was a fat kid until age 16), was eating a pretty darn good Mediterranean type diet (Italian American wife who is a great and aware cook), have had acceptable cholesterol levels. I visited a preventive cardiologist and started Zocor in hopes of dropping my 95 LDL level below 60 in an attempt to reverse the plaques. I am now on a Dean Ornish-ish diet as well. Any suggestions on what I might do to stop this before I do have an MI (and perhaps die from such)? What is going on? I am scared. Thank you for any insight anyone may have!
Dr. R., Pennsylvania, USA, February 14, 2008

• I had a des in 2/05,and put on various heart meds.In 4/07 I had a thallium stress test showing positive! Waited until 11-07 for a heart cath. Dr.said I needed a triple by-pass immediatly.Well now it is 12-28-07, no by-pass done and still alive! I have been thru three cardiologists over the last year due to not listening to my concerns about drug reactions,etc. (like them knowing everything and you being ignorant.) I have done so much research on the internet about the heart and I feel betrayed by the medical community for all the trust I have placed upon the guys in the white coats. For the most part they either lie to you, ignore your complaints, like my severe joint/muscle pains or are arrogant and belittling to you. I wish I could leave this planet at times out of medical frustration. I had asked my last cardiologist the cost of a cath he wanted performed and he said approximately $7,000 to $9,000 dollars.Well my bill came in for 18,800 dollars.They don't have a clue about the cost of these procedures they order today.The surgeon talking to me in the cath recovery room saying it was imperative that the triple by-pass be done immediately. He was asked by me of the "COST" of the procedure.You will laugh at his response! $50,000.00. Most of us have heard of the cost ranging from 100,000.00 and up, surely higher with complications (major surgery you know). So at home I stay,(alive anyway) far away from these crack pots and their evasive, expensive, and experimental procedures, hoping for death to rescue me from this life's medical madness. Happy New Year every one!
G., Canton, Georgia, USA, December 27, 2007

• my dad had no symptoms before a stress test was performed. was told he had 98% blockage and was a heart attack waiting. he had angio w/5 drug eluting stents and did well. the dr. could not complete all the clogs because of two much trauma for the body. three weeks later he had two more stents put in and never really felt well. one month later rushed to er in pain, some sort of scar tissues needed to be cleaned out. continues to have pain, fluttering, and problems walking more than 10 min. dr. says he is fine. changes drs for second opinion and has an another stress test and does "terrible", "everything is all over the place" new dr. says probably cannot get any more stents will most likely need open heart surgery. My dad never had a symptom before it had the first stress test. is open heart surgery still done and what would make his problem so severe.
nancy rodriguez, New Jersey, USA, June 29, 2006

• In July, 05, I had quadruple CABG, 3-SVG's and 1-LIMA. 2 months later (9/05), mild MI. Angiogram found that all 3 of my SVG's were scarring internally - 95%, 98%, and 100%. 2 Cypher stents in the SVG to LCA, one in the SVG to RCA, SVG to circumflex "lost". Within 2 months, I was experiencing chest pain again, took a nuclear stress test January, 06 - "passed", pressed the issue (pain was getting worse), angiogram in March, 06 found 95% blockage inside the 1st stent, SVG to LCA. Cleared scar tissue and put in another stent inside the existing one. Pain continued worsening, In June, 06, another angiogram, 85% blockage inside the stent SVG to RCA. After that one, I am STILL having discomfort. Bypass surgery, then 3 stenting procedures in 9 months - I'm on Plavix, Zocor, aspirin, Altace, metroprolol, and supplements - cholesterol down to 129, and I exercise every day...2 cardiologists, both of which I like and think are capable, but they don't seem to be able to suggest alternatives to just repeating the past.
Bruce Parker, Rosenberg, Texas, USA, June 22, 2006

• Response to Gary NcCleary, Roseburg Oregon: "To me sounds like better to be opened up and have the grafts performed and be done with it? Or does restenosis occur as often in bypass?" Regarding restenosis in bypass surgeries: Some do and some don't. But, aside from that, you have a higher risk of death during or soon after bypass surgery i.e., 1-3%. And, in addition to that, you have a higher incidence of side effects, and while 60% have no problems recovering from the procedure, some 40 % of the patients do, especially witth cognitive dysfunction which can occur in this unfortunate but still substantial miniority of the cases. Most of that is dismissed rather cavelierly, since the majority of patients are back to normal in 3- 12 months but during that period the patient may be handicapped by confusion, memory problems and, in general, a slight loss of intellect i.e., as in 5-10 IQ points. Most importantly though, is the fact that for a significant percentage of this sub-group patients, their cognitive dysfunction is more profound and for this smaller group, they may never be themselves again. Some go straight to nursing homes for the rest of their lives. Don't take my word for it. Just check out Bypass Heart Surgery and cognitive dysfunction on Google. Look for the studies done at Duke University! I noticed you didn't mention the feasibility of opting for any other treatment options and that is probably because you may not be aware of any other treatment options. There is a VERY SAFE, FDA approved NON- INVASIVE treatment that is covered by CMS and most insurance companies for Class III and IV angina. Besides reducing the pain and shortness of breath of angina, It also improves the functioning of the vascular system which can dramatically reduce the incidence of restenosis and actually increase collateral circulation to the heart itself. And, it generally costs less that the sales tax on a bypass surgery. It is most commonly referred to as Enhanced External Counterpulsation (EECP) and is generically referred to as ECP. See www.eecp.com and if it sounds reasonable to you, just ask your doctor nicely if he will let you try it. Chances are good, if you really want the treatment, he will cheerfully oblige you.
Gerald Oros, , Collinsville, May 5, 2006

• "Joe, Retired Amy, Jax, Florida, USA, 9 May 2001" . . . I just read your posting. . .Have you had the Anthrax Vaccine?? Anyone know this person or his Email address? PLEASE have him contact me immediately at AVAVICTIM@YAHOO.COM We seem to share the same exact course in getting stents. I also have 15 Stents installed with 7 angioplasties over a 28 month period. RCA and LAD . . . No MI YET!
RayZ, San Diego CA, December 7, 2005

• Dear barbara john and joe I know a case in our family circles. To the person instent-restonsis occurred within three years after insertion of one stent. Second stent was suggested butHe refused. He stopped taking medicines He started taking vitamin c and Linus'Pauling's Heart technology one jar a month. He is able to work. He said all pains, sleepy feeling, etc., gone. It is a high dose of vitamin c, between 3000 mg to to 9000 mg or more and few other ingredients. FDA suggests upto 90 mg or so only. If you are interested You can try. It cosats about $50 per month. You may give a try. I am in no way connected with this product
Venkata, California, USA, November 12, 2005

• I HAD ANGIOPLASTY ABOUT 8 YEARS AGO. THEY SAY EVERYTHING IS OKAY BUT AFTER DOING A LOT OF READING & WONDERING WHY I AM EXTREMELY TIRED AND HAVE MUSCLE ACHES I CAME ACROSS AN ARTICLE THAT SAID THAT WHEN YOU ARE ON ZOCOR YOU SHOULD BE TAKING CQ10 - (GEL TAB) HAS ANYONE HAD ANY LUCK WITH THIS OVER THE COUNTER VITAMIN
MARGE, CHICAGO, IL., 22 Apr 2003

• Dear Barbara and John, I am 46 yr old male, retired army, and had 3 MI's in the past year, and 5 angioplasty's mostly in my RCA, every 2-3 months I get a 95 to 99% blockage in the RCA, and now the LAD, I have stents on top of stents in the RCA (i believe 12 in all have been inserted in the RCA, and 3 in the LAD. My most recent was last week when i went to the e.r with chest pains and when they did the cath procedure they found the 2 blockages. I guess my question is, can either of u 2 help me also in finding out, if i should get a bypass. I also have uncontrolled High Blood Pressure. I don't think they can put any more stents in the RCA and I know that within 2-3 months I'll be back in the hospital. Also, I wish You 2 the best of Health.
Joe, Retired Amy, Jax, Florida, USA, 9 May 2001

• Dear Barbara: I have the same symptoms that you have! I have also been told not to worry! Have had three angioplasty procedures with a total of two stents and two "rotoblatures" ["Rotablations" -- ed.] since October 1999. (Last one in January, 2000) Have been told I should not be dizzy or light-headed and should not have arm pain. (Both arms ache.) I know my pain is real and something is wrong.. Please let me know if you have found the cause and a possible solution. (Also, I am a 46 yr. old male.) Thank you!
John D., Ohio, USA, March 12, 2000

• Barbara, Usenet newsgroups are often an excellent way to join into a community. They've been around longer than the World Wide Web or the "chat rooms", run by corporate entities. You can find a listing of the relevant cardiology newsgroups at the bottom of our LINKS page. I would recommend the support group for angioplasty patients alt.support.angioplasty. It's a relatively small group of patients, but among them they have quite a few stories to share. If you have trouble getting onto the group, talk to your ISP (not all newsgroups are carried by all ISPs) or contact them via deja.com. Good luck!
Angioplasty.Org Staff, PTCA.ORG, February 16, 2000

• I had 4 angioplasties in 1 year. The last was 2/3/00. Does anyone else have a feeling of a tight band around their left arm? Have it most of the time. I also have numbness in my fingers & toes and the tips of the fingers are actually purple. This happened yesterday and then I felt lightheaded and dizziness. I called my Doctor and he told me not to worry, but how can you help it? Would like to hear from others with any type symptoms after/before their procedure that would make them feel that things are not okay. I need a support group to help me with my anxieties as I have no faith that this will not happen again. It's driving me crazy and interferring with my work and life. I am 62 and need to work. Any support will be appreciated. Thanks.
Barbara Mollberg, Milwaukee, Wisconsin, USA, February 16, 2000

• On Dec 1, 1999 I had a "mild" MI. Angiogram performed showed about 95% blockage of the LAD. Angioplasty with 3 stents performed. Well about 3 weeks ago I started to notice numbness in both arms from elbows down (Same with MI) A Cardiolite stress test was performed and showed there to be blockage at the original sites as well as down from site. Question is at this point do I just elect for Bypass? These angioplasties are not cheap and if they keep coming back so quickly what is so wonderful about them? To me sounds like better to be opened up and have the grafts performed and be done with it? Or does restenosis occur as often in bypass? Thanks.
Gary McCleary, Roseburg, Oregon, USA, February 8, 2000

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