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Can Small Arteries Be Stented?

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I have a 95% blockage of the LAD and an 80% blockage of the diagonal branch. The doctor told me that he couldn't find a small enough stent to insert in the arteries so he didn"t complete the event. My cardiologist agreed and he also said bypass surgery would be too extreme. Something is wrong here. What do you think? Help! I have no pain and I perform most work except running, etc. I think I need stenting or bypass
Carl Laurino, Valley Stream, New York


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Current Postings on This Page (62):

• Dee in Chicago -- First of all, as we state on every page of the Forum, no information on this Forum should be viewed as a substitute for medical advice or as a consultation with a medical doctor. Good that you were able to speak with your cardiologist and it's important to understand his recommendation for an angiogram. As noted in our last response, an angiogram is considered the next step for a patient with your symptoms and test results. If his interpretation is that your stress test showed "significant" blockage, that would back up his decision even more. The decision to move forward from a diagnostic angiogram to a stent procedure (called ad hoc PCI) is a discussion that you might want to have before the angiogram (again, see our report on Ad Hoc Angioplasty which details the SCAI's consensus statement on this issue). As for EECP, there is a Forum Topic on EECP -- it is normally used for patients who have not obtained relief from angina, even after stenting or sugery. It is available in many hospitals for that reason, but it's not a substitute for bypass surgery or stenting. Check out this article from Dr. Andrew Weil, an icon in the field of alternative medicine in which he discusses this with a cardiologist from, of all places, Northwestern!! It's unfortunate, however, that your cardiologist called EECP "hogwash" -- it seems to have had exactly the opposite effect from what he intended....
Angioplasty.Org Staff, Angioplasty.Org, February 11, 2013

• Thank you for your response. I did talk to the Dr. by phone today after telling his nurse I was cancelling an angiogram scheduled for tomorrow. Dr. conveniently called me back. Based on my history he's insisting on angiogram saying the stress test showed significant blockage. I have been reading about EECP, he says it's hogwash. I'm afraid of angiogram and stenting. I read good things about EECP. Has anybody experienced any negatives. I'm thinking of putting off angio and trying EECP first.
Dee B., Chicago, Illinois, USA, February 11, 2013

• Dee in Chicago -- You're right that Northwestern has an excellent reputation, and they have some of the top interventional cardiologists in the country, if not the world, there. According to the guidelines, if a patient is experiencing angina, and a functional stress test shows possible ischemia, then an angiogram is the next logical step to confirm or rule out some type of blockage. However, your ability to have a discussion about your course of diagnosis and treatment is now also part of the guidelines. Read our report, New Guidelines for Stable Heart Disease: Emphasis on Patient Involvement, "Holistic" Approach, and you'll see that the cardiologist-patient conversation is now considered an integral part of the therapy. This is a bit of a change and many in the healthcare field are still "getting with the guidelines." One real problem is that physicians have so little time to devote to these types of issues and there is yet no reimbursement to them for this time. Our related report on Ad Hoc Angioplasty discusses this in more detail. You may have to insist on this discussion, but the purpose is to help you understand why something is being proposed, so that you can become a partner in your own healthcare.
Angioplasty.Org Staff, Angioplasty.Org, February 8, 2013

• I'm a 65 yr old diabetic female with high BP and anemia who had a drug eluting stent in a large artery because of a "subtle mild heart attack" in 06/2011 and blockages in 3 small arteries unable to stent. I've had angina from day one on some days not all; I've noticed it more if my blood sugar is high. Nitro and/or Isosorbide was recommended but I do not take either. I had to change Drs. and the new cardio ordered an echo stress test which showed some blockage with ischemia (even on the EKG). He wants to do an angiogram on Tues. and I am terrified because of its own risk. I have had two before. I'm put off that following the stress test the attending Dr. reading the results told me she saw some blockage and would call my cardio who would call me. The only call I got was from a scheduler calling to confirm the procedure scheduled for Monday. I declined until I could talk to him or nurse. That shook my confidence even though Northwestern Hosp. in Chicago has an excellent reputation and this is his specialty. I've only seen him twice. Do I have options? Also, is it true that once there is plaque in the arteries it can't be dissolved? Reading some of these comments I see EECP. Enlighten
Dee B., Chicago, Illinois, USA, February 8, 2013

• Stenting in India -- 2.5mm is a relatively small diameter. If your cardiologist said it was too small a territory, he may have been referring to the amount of heart muscle potentially being fed by that small distal (close to the far end) part of the artery. If small, then opening up the blockage might not yield much, while you'd risk a complication. In other words the percentage of risk might be greater than the percentage of benefit possible.
Angioplasty.Org Staff, Angioplasty.Org, date, 2012

• I developed acute anterior wall MI. After 18 hr I reached a hospital where cardiologist did CAG which revealed single vessel disease, distal LAD 100%. It was nearly 2.5mm in size nearly at the apex. Doctor didn't do stenting. I am confused. I don't have chest pain now. Why they didn't put a stent there? They say that its too distal with small territory. Please help.
Stenting distal LAD, India, October 18, 2012

• Clearwater Al in North Carolina and Grandnorty in Pennsylvania -- small arteries probably are not supplying a large amount of blood flow (hence oxygen) to the heart muscle, so a closing up of these probably will cause angina, possibly even an infarct -- hard to predict the likelihood of that -- most likely not a fatal one, assuming there is sufficient blood flow from other channels. We certainly advocate getting second opinions, if only to verify the first one and put you at ease regarding what's been recommended. Sometimes one interventional cardiologist may have more experience with stenting small arteries than another and may give a different opinion. As for angina, there are anti-anginal medications for refractory angina, such as Renexa.
Angioplasty.Org Staff, Angioplasty.Org, September 29, 2012

• I am a 79 yr. old male with chronic angina. I have had two open heart surgeries, 1981 CABGIII AND 1995 CABGIV. I have recently been hospitalized with congestive heart failure and recuperating satisfactorily. I was advised recently that my arteries are too small to stent and that there is a possibility that my grafts cannot be stented. I have had many catheterizations and the dye may too risky for another. I still have angina too often and I hope there is another option so that I can have stents so that I can avoid angina, such as stents or what ever can be done so that I can exercise and feel better. No one wants to open me up again. Too risky! please advise or suggest what can be done. Thank you
grandnorty, Warminster, Pennsylvania, USA, September 27, 2012

• I have been told I have two arteries too small to stent or by-pass. I asked my doctor what happens if one of those should develope a blockage and he frankly told me I'd have a heart attack that my hospital can treat and unlikely be fatal. I don't remember the terminology but something like "these arteries are not extremely critical if one occludes." But I've read any heart attack can be fatal. My larger arteries are very open. (Had by-pass on the left-descending 15 years ago. Am I getting the honest story?
Clearwater Al, Level Cross, North Carolina, USA, September 2, 2012

• Broken hearted in Mumbai -- First off, we think you mean "angioplasty" with stents, not "angiography." You certainly have significant blockages, but it's impossible for anyone not looking at your clinical records and your angiogram to give you specific advice. Certainly do what you can to reduce the risk factors under your control (stay compliant with your BP and cholesterol meds, etc.). Have you had a stress test to measure whether or not you have significant ischemia (lack of oxygen to the heart muscle). Also, since you've had a heart attack, was there significant damage to the muscle? Yours is a complicated situation. Do the cardiologists who are recommending stenting use FFR? You might want to ask them and also read our article on Fractional Flow Reserve (FFR).
Angioplasty.Org Staff, Angioplasty.Org, August 30, 2012

• i am male, 36 yr old, was admitted to hospital in emergency a month back and diagnosed with inferior wall myocardial infarction c.o.d. on doing angiogram following results: lad: 80% stenosis RCA: 99% stenosis. i am diabetic, had high BP and high cholesterol. now i have shown my reports to a few docs and they have conflicting recommendations... 1 said i should just do medical treatment because my arteries are thin, 1 said EECP and 2 said angiography with 2 or if need be then 3 stents.. not sure who to go with.. don't wanna do angiography and then regret it later as i know it cant be reversed.. at the moment i feel perfectly normal unless i walk fast for more than a km wherein i feel breathless and sometimes pain in chest. i am so confused and dunno what decision to make...
broken hearted Mumbai, Mumbai, India, August 21, 2012

• I had 3 stents put in the arteries in the heart 2 yrs ago and 1 was the diagonal.
Alysa, Lagrange Park, Illinois, USA, July 15, 2012

• Tracy in Arkansas -- It may be that the small artery is not a major source of blood (and oxygen) to the heart muscle -- and arteries that are too small to stent are most likely best left alone because adding a stent in a very small low-flow artery might actually increase the chance of blockage (restenosis). Your dad should do everything he can to lower his modifiable risk factors: stay on the prescribed meds, watch his diet, stop smoking (if he does) and try to get as much exercise as he can. Those are the best things he can do to slow any progression of his disease.
Angioplasty.Org Staff, Angioplasty.Org, July 15, 2012

• My dad had 70 percent blockage in his heart they stented 1 and the doctor said the other one was too small to stent. I ask the doctor what else could be done and he said nothing, my question is will that small vein get more plugged and cause other heart attack? He is on Plavix, blood pressure, and a heart rhythm pill. Can somebody help me out? Thank you
Tracy, Springdale, Arkansas, USA, July 12, 2012

• Paula -- Have you been evaluated by an interventional cardiologist (the specialist who performs angioplasty).
Angioplasty.Org Staff, Angioplasty.Org, July 4, 2012

• I had open heart surgery to do double bypass should of been triple but was told one artery was to small. Now I have only one major artery that is completely unblocked, they say they can not fix any of the others that are blocked because my arteries are to small. I feel like I'm being blown off and doctors saying there is nothing they can do. Because my main arteries are so small. Any opinions or suggestions?
Paula, Dothan, Alabama, USA, June 26, 2012

• My mother had greater than 90% blockage in her right coronary artery. Her local cardiologist was unsure if they would give her a stent. I took her to my local, big city hospital at the Hospital of the University of Pennsylvania (HUP). The interventional cardiologist at HUP said it took some work and over an hour to pick the appropriate drill bit to drill through the calcification and per my mother, the doctor may have had to machine a few stents to get them to fit in her small artery. However, the doctor was successful and my mother's heart is fine two years later. So maybe big city, research hospitals have more options as far as stents and drill bits go for women and for anyone with small arteries.
samsid, Philadelphia, Pennsylvania, USA, March 14, 2012

• If you are suffering from angina pain and yet your doctor feels that none of the arteries that might benefit from a stent are simply too small to physically accommodate even the smallest ones manufactured. In this kind of case, it is often called microvasculature angina or cardiology syndrome X. You're going to have to firmly demand EECP treatment, they'll never likely to suggest it themselves, See study below at www.vasomedical.com.
Gerald Oros, EECP Patient Veteran -5 Full Treatments, Collinsville, Illinois, USA, January 11, 2012

• Cynthia O in Mississippi -- A 30% blockage is not considered significant. 80% is, but it also depends on which artery it's in, what part of the heart muscle is supplied by that artery, whether or not you have developed collateral circulation, etc. The question also is whether or not the 80% lesion is causing ischemia (reduced blood flow) significant enough to warrant an intervention. This can be determined at the time of the angiogram using "fractional flow reserve", but many cardiologists do not use this technology. Do you have symptoms? Have you had a stress test?
Angioplasty.Org Staff, Angioplasty.Org, October 30, 2011

• I am a 53 year old female that just found out that I have one artery 30% blocked and one 80% blocked. My cardiologist says my arteries are too small to stent. Any advice or information would be greatly appreciated.
Cynthia O., Pontotoc, Mississippi, USA, October 29, 2011

• Flintridge in Oklahoma -- Women in general tend to have smaller arteries than men. Whether the fact you have small arteries in your arm pit translates to having small coronary arteries which are causing cardiac problems (shortness of breath, etc.) is not possible to say, especially since you have had other issues. Women also tends to have a greater degree of microcirculation in their hearts, very small vessels but a lot of them, so blood and oxygen do get delivered to the heart muscle sufficiently.
Angioplasty.Org Staff, Angioplasty.Org, March 23, 2011

• I have had a serious history in the last year. Antiphospholipid & ? Lupus Cerebritis. I went to the breast doctor and he noted that my arteries in my arm pit are extremely small. He said that they were pin like. Could this be the problem with short breath or tightness in my chest? I cardio exercise 5 times weekly for 1 hour and seem to be okay when doing that but walking up stairs or hills takes the wind out of me. Could this reason be narrowed down by knowing that I have very small arteries?
Flintridge KS, Kansas, Oklahoma, USA, March 23, 2011

• Carol in Florida -- We are not familiar with the CV Profile test you speak of. Can you send along more information or a link?
Angioplasty.Org Staff, Angioplasty.Org, February 3, 2011

• Well I found a test that test your small arteries, although doctors don't believe in this test, doctors up north do? Lately Doctors in florida only believe in what they think they are not open to new technology, so going to have test called CV Profile test tells whether your small arteries are clogged, plus they will do other test about my small arteries, on west coast of florida, Having 15 test and takes about 3 hours, so wish me luck, test on Feb 21,2011. Don't dare go to Doctors in volusia county, Florida. They are all money hungry and all you are is account number?
Carol, Deltona, Florida, USA, February 3, 2011

• Carol in Florida -- the smaller arteries, sometimes the very small (called the microvasculature) can be a cause of angina. This is especially true in women. In our recent interview with Dr. William Fearon of Stanford, he discusses studies he and his colleague, Dr. Jennifer Tremmel, are doing in this area. While these vessels are too small for stenting, there are anti-anginal medications (e.g. Ranexa) that can help relieve the symptoms. As for the rest of your post, you certainly sound stressed and depressed. There are numerous studies linking these to increased pain and other physical manifestations -- also to heart disease. You're also dealing with COPD (we assume you do not smoke). Any type of stress-reducing activities would help. Don't know if there are yoga classes, or other similar activities, but meditation, relaxation exercises, etc. can be very helpful -- and also may connect you to other people in your community. Possibly your cardiologist or doctor can recommend some??
Angioplasty.Org Staff, Angioplasty.Org, January 8, 2011

• My small arteries are blocked and have lots of pain, have had 4 cardiac catheterizations, but large arteries are fine, also just has this past summer and angiogram of arteries in neck, but they too are fine, but besides having COPD, I get out of breath fast, have no energy and have bad high blood pressure and lots of stress, and can't get rid of it, cause hate where I live and can't sell my home cause paid to much in 11/05,and now homes in central florida are selling for nickels and dimes compared to what I paid, did to home and a stupid large down payment, so feel doomed, want to move back north but homes are still quite expensive, so need equity to buy a home in NEW ENGLAND, hate where we live and it is very boring, use to live near ocean, now living inland with boring neighbors? no family around or friends all moved away and will not visit florida ever again? Pray homes rise in central florida soon, before I die, from unhappiness.
Carol, Deltona, Florida, January 7, 2011

• Laura in Virginia -- Sometimes obstruction in the small arteries, like the right posterior descending (PDA) can cause angina, even though it's not the source of a significant oxygen deficit to the heart muscle -- something that would not necessarily show up on a nuclear perfusion study.
Angioplasty.Org Staff, Angioplasty.Org, September 5, 2011

• Can you have a normal stress test and nuclear perfusion study but have two positive characterizations for branch disease (D1; D2 and Ramus and posterior right descending) 80% and above and still have angina? (He is post MI RCA) One of the doctors say my husband has depression. He is not depressed. Now and then angina like pain in jaw, chest and back. Frustrating to be told he doesn't have a heart condition when the caths says that he does. He has extreme headaches and fatigue which seem like they might be RX related. Anyone have problems with Plavix? He doesn't have any other medical conditions and other Drs say he is fine otherwise.
Laura, Abingdon, Virginia, USA, September 1, 2010

• my age is 32 lmca 35% rca70% and have diagnals thin vessels one cordiologyst told that your viens is very small that condition is not comfort to cabg you continue old medicine. but what is the my heart condition I dont know. now I have a any serious conition? please give reply anybody for my doubt ramakrishna,uae.
what is my health condition, electrical, ras al khaimah, United Arab Emirates, August 18, 2010

• Madmatt in Missouri -- Stents only go down to a certain diameter -- we believe 2.25mm is the narrowest. Although a balloon angioplasty can still be performed in a narrow vessel -- just no stent left behind, so reclosure is a higher risk. Did you cardiologist do a balloon dilatation? FYI, even after angioplasty and meds, a not insignificant number of patients still experience angina -- there are anti-anginal medicines, such as Renexa (Ranolazine) that may relieve the pain.
Angioplasty.Org Staff, Angioplasty.Org, June 30, 2010

• I'm a 40 year old male quad bypass in 04' recently I've had angina and pain in the back of my arms, my cardiologist tried to perform a stent on a horizontal artery, it was too small and is now treating with meds, I'm still having angina and anxiety. I've been assured that this will pass as all other vessels seem well. Question... when will the hurting stop? except for this small vessel I'm great but it's very frightening.
Madmatt, Independence, Missouri, USA, June 24, 2010

• Carl Laurino, I sure would get another opinion at one of the top notch hospitals in New York City. David Letterman and Regis Philbin (sp) both used the same highly qualified group of doctors at Cornell-Weill Teaching hospital there in NYC. I also see doctors at a Cornell Weill based hospital in Houston. I also was told by cardio's that I have an area in the distal LAD that cannot be stented or by-passed. Some new smaller stents came out but were still too big for my tiny artery. I am treated medically until a time comes that the best stent for me comes on the market. I know how frustrating it is. No two cases are the same and I suggest you need another opinion at a large teaching hospital with experienced cardiologists. We all deserve and need this. I wish you all the best.
Kathy Laurio, Houston, Texas, USA, July 26, 2009

• MB -- this is really a question for your uncle's cardiologist. It may be a question of your uncle's clinical status -- that is, he may be too ill from other problems to withstand an operation. This situation is one where interventional procedures, such as angioplasty, may help because they are far less impactful on the patient's system. But perhaps the blockage or blockages are in difficult-to-access locations, or are chronic total occlusions which are not able to be opened. Or perhaps the blockages are in arteries that are too narrow. We'd suggest talking to your uncle's cardiologist and asking more specifics so that you can help your uncle understand, or perhaps you may want a second opinion. Every month newer and newer stents are being designed that will better stent narrow arteries. Regarding speaking to the cardiologist, we recommend to all our article, "You and Your Physician". Let us know what you find out.
Angioplasty.Org Staff, Angioplasty.Org, July 22, 2009

• My uncle's cardiologist said my uncle was an inoperable cardiac patient. Does this mean he would not be a candidate for bypass and angioplasty or does this just refer to surgery, bypass?
MB, Massachusetts, USA, July 15, 2009

• Eve -- you report that your artery was 95% closed. Which artery is this and what did the cardiologist advise?
Angioplasty.Org Staff, Angioplasty.Org, May 15, 2009

• I am a 63 year old woman with unstable angina. The doctors did not take me seriously because I passed all the tests with flying colors. Only when I asked what they would tell my family I died from did they take a look and found the artery was 95% closed. I continue to have angina attacks that I really feel I am going to die. The doctors can not find a problem. If it is the small microscopic arteries or hardening of the arteries there is nothing they can do. Do I take my nitro until I have a stroke or have an aneurysm. This is very scary and I have no answers.
Eve, Michigan, USA, May 10, 2009

• at 32 yo, i had 80% blockage of my LAD-stent was placed. at 36, my cardiologist could not get into my 1st diagonal branch. he said it is unable to be stented. i have chest pain and sob. what do you recommend?
Karen, Monroe, Louisiana, USA, May 7, 2009

• I just had an angiogram done and was told the right coronary artery was too small to do angioplasty and that it would compensate on its own. Is this true or do I need to see another cardiologist?
Susan C., Georgia, USA, May 30, 2008

• Z.-- best person to ask is an interventional cardiologist -- the specialist that does angioplasty and stents. Have him/her look at your grandfather's angiogram. They will be able to see the coronary anatomy and determine if stenting is possible and would be therapeutic.
Angioplasty.Org Staff, Angioplasty.Org, May 16, 2008

• Hi my grandpa just had a heart attack they couldn't do surgery because he had small veins/arteries. would a stent be an option for him?
Z., Wisconsin, USA, May 14, 2008

• C.S. in San Francisco -- if a 3mm stent was used, that's not a "small" artery (small would be as you approach a 2mm diameter). If your heart attack was caused by a subtotal blockage in your circumflex, then the stent will keep that lesion open, preventing future episodes, something that cannot be done via meds alone, etc. And the risks that you read about are small -- for example, late stent thrombosis is a very low frequency event. All good practitioners are against putting in stents when they're not needed, but it would seem in your case (and this is NOT a substitute for a qualified medical opinion) it was needed. Furthermore many patients who have had angioplasty and stents go on to continue full lives -- our topic on Exercise Post-Angioplasty has numerous posts from bikers, marathon runners, etc. Prior to angioplasty (30 years ago) you would have been put on meds (which were primitive compared to today's) and told to scale your life way back. Or you might have had a bypass, which would have achieved the same result as your angioplasty, with much greater recovery needed.

And Fady -- whether a stent is right and, if so, what type (drug-eluting or bare metal) is a question you should discuss with an interventional cardiologist. Make sure you understand what medications (like Plavix) you may need afterwards and for how long. Each patient's clinical situation is different, so advice cannot be given without seeing the whole picture (and the angiogram). Are blockages like this dilated and/or stented? Sure. But the question has to be is this blockage causing you a problem? And will this treatment solve that?
Angioplasty.Org Staff, Angioplasty.Org, February 26, 2008

• I HAVE A 50-69% BLOCKAGE IN MY PROXIMAL DIAGONAL D1 BRANCH. MID ARE NORMAL AND IT IS A SMALL VESSEL , CAN STENT BE OK IN THIS CASE?
Fady S., California, USA, February 10, 2008

• i had a 3mm drug eluting stent placed in my almost totally blocked circumflex after a "mild heart attack". I'm 55, a 145 lb health nut and a runner (Or, I was) Now I'm reading about all the long term risks of what's inside me and the drugs I'm on for life. Will I ever run again? Also, everything I read about stents says "...helps you live a longer life.." It never says a "long life". If I'd had it explained to me before they did it, as it should have been, I'd have passed and gone just for meds. Can I live a long life now, or is this just procedure #1?
C.S., San Francisco, California, USA, January 8, 2008

• Maureen -- Hi I too am UK patient. Also I too have had 2 stents fitted to 1xRCA and 1xLAD But still have chest pain with only v moderate workload, and have tired legs after walking just small distances. I use Nitro Patches (5mg) during day and no doubt that I get relief using them. I know I could increase to 10mg per day but need to watch BP doesn't go to low But i also have atrial fibrillation which might be causing some problem on top of the artery one. However despite failing my last Treadmill Stress it is suggested that I remain on Medication, as the arteries further down the line are not too good either. So whether what is actually happening is that they wait until the drugs don't work anymore and Bypass is necessary I don't know. (I don't imagine they would say) But another drug called NICORANDIL and apparently works like nitro, have you tried that? I know its all a bit difficult, because no doubt you like me cannot get `fit` due to getting tired and exhausted before you can do any good.
TM, United Kingdom, December 1, 2007

• I HAD SURGERY LIMA TO LAD AND TEN DAYS LATER I HAD TO HAVE STENT PUT IN BECAUSE THE SURGEON OVER-STITCHED THEM AND BLOCKED THE BLOOD FLOW. HAS THIS HAPPENED TO ANYONE?
Andrew, Florida, USA, November 29, 2007

• A.C. -- curious as to what test showed the blockage? An angiogram would have not only shown the 70% blockage, but would specifically have shown whether or not there were blockages farther down the LAD (left anterior descending). Not sure why stents may not be possible because the LAD is usually one of the largest arteries in the coronary tree and stents are manufactured down to size at least 2.0mm in diameter. But the decision as to whether surgery, stents or medical therapy is the best treatment is something you need to do with your cardiologist. If you have questions, make sure they are answered. The COURAGE Trial showed that medical therapy PLUS lifestyle changes alone can achieve quite good results -- but if a patient doesn;t react well to the drugs, or has continued angina, OR is judged to be at high risk for an adverse event such as a heart attack, then a more aggressive approach may be warranted.
Angioplasty.Org Staff, Angioplasty.Org, October 25, 2007

• my left anterior descending artery is 70% blocked near the top and may have other blockages further down. Stents may not be possible because of artery size and bypass may not be possible because of blockage through artery. How effective is medicine in this case.
A.C., Maryland, USA, October 23, 2007

• I just had an angiogram done due to a mibi showing ischemia of the lad. They have found that my arteries are very small. I suffer from angina and can have an attack from cleaning the house or walking up a flight of stairs. Can anyone relate and give some help as I just had it done and have yet to see my cardiologist again.
L.K., British Columbia, CANADA, October 22, 2007

• Maureen -- you are not alone and there are therapies, such as anti-anginal drugs, alternatives like eecp and others. What you are describing is the subject of our interview with Dr. Robert Engler in our Angiogenesis Center. There is a clinical trial currently enrolling in the U.S. to see if angiogenetic therapy might be helpful in situations like yours.
Angioplasty.Org Staff, Angioplasty.Org, July 17, 2007

• I have angina and after having angiogram which was negative they have told me that its the small arteries which are causing my angina. I cannot even walk a mile and are very tired. Medication doesn't seem to do the job and have been told its called syndrome X because there is nothing they can do because its not the main arteries. I suffered from pain my my legs. Does anyone have the same problem.
Maureen, UK, July 17, 2007

• my friend had somewhat similar to your case and his doctor advised for bypass. i don't know what happened, whether the bypass surgery was indeed carried out or not.
M., USA, September 25, 2006

• Tom -- as we always ask, have you discussed this with your mother's cardiologist? Some blockages are hard to navigate to because the artery is too tortuous or twisty. Whether or not that blockage is causing a problem is something that may be told by use of a "functional" test, like a stress test, which measures not just whether there is a blockage, but whether that blockage is causing ischemia. Pain is very subjective -- there is also the possibility that a drug that has been prescribed is causing fatigue or muscle cramps (a side-effect of statins). Again, every patient is different. Your cardiologist has access to the angiograms and should be able to guide you further. Let us know what the cardiologist says.
Angioplasty.Org Staff, Angioplasty.Org, August 21, 2006

• My mom just recently had an angioplasty procedure performed and a coated stent inserted. She also had another artery blockage that the doctor said he could not get to. So, basically, she still has one blockage but the more pressing problem is that she cannot do much of anything without getting tired very quickly and especially her legs get tight when she tries to walk. Her knees, calves, tighten and start to ache and she can feel her heart pounding away. When she stops and rests, the ache seems to go away. She was, before the procedure, a very active woman, and I am trying to get as much information as to what can be done and whether the other blockage is causing the problems with her legs and getting tired. I have not been able to find much information about this.
Tom Ross, Houston, Texas, USA, August 20, 2006

• A news note: Medtronic just received FDA approval for a small (2.25mm - 2.75mm) bare metal stent, the Micro-Driver, made of a cobalt alloy which ostensibly makes it possible to have a stent with thinner struts, making it more flexible, without sacrificing strength.
Angioplasty.Org Staff, Angioplasty.Org, May 2, 2006

• Susie -- coated (or drug-eluting) stents have performed very well in narrow arteries which are at higher risk for restenosis. But placement of a stent in an area that has no plaque is not something we have heard of -- guidelines from the AHA & ACC state that interventions should not be done in vessels less than 50% blocked. That being said, we are not medical doctors and every patient's clinical picture is different -- this may be a unique situation and there may be some good reason why this is being suggested (we're assuming this was suggested by an interventional cardiologist). Ask questions why and find out to your satisfaction, get a second opinion if you're still concerned, and definitely post your findings to this Forum to help other readers.
Angioplasty.Org Staff, Angioplasty.Org, April 24, 2006

• A friend has had it suggested to have a coated stent implanted in a non-obstructive but narrowed area of his very small vessel off the LAD. Vessel form is congenitive and does not have any plaque. Is procedure necessary?
Susie M., Indiana, USA, April 24, 2006

• My cardiologist is keeping an eye on some small diameter DES products which he says should be on the market within 1 year. Had CABG 2 years ago. 1 of the grafts failed so they may have to stent a very narrow and long artery. Am diabetic but in good health and waiting to see what happens.
Richard Zammito, Clearwater, FL, January 29, 2006

• My cardiologist tried to stent a artery that was too small (2mm) to stent. He made a tear in my artery wall causing me to have a heart attack, while in the cath lab. Has anyone had this happen to you. Lily
Lily, Monticello, Kentucky. Wayne, January 23, 2006

• I had a balloon procedure in the branch off my RCA. Doctor said because it was too small for stents. Have you asked about the balloon procedure?
Dana S., Fremont, CA USA, December 05, 2005

• Carl: You do seem to have a problem, especially if your cardiologist is right about bypass surgery being too extreme for your condition. I previously suffered from angina symptoms (shortness of breath and pain) and ischemic heart disease and I'm much better today as a result of a FDA approved, Medicare reimbursed, non-invasive treatment, Enhanced External Counterpulsation (EECP) Officially, it's supposed to be used only when a patient is no longer a good candidate for further invasive revasularization procedures... That sounds like it might be you... But I received my EECP treatment only after studying it thoroughly and then going to a cardiologist and specifically/firmly requesting it. I was also careful to refuse an invasive angiogram because I agree with the new school of thought that believes that heart disease is most often the result of systemic vascular disease which is thought to be caused by inflammation and constriction ---- which results in many vascular lesions throughout the entire vacular system. Those lesions, in an attempt to heal, develop plaque (like a sore develops a scab) which can often be unstable. An angiogram performed with a catheter can bump a lesion which may have their plaque protruding (some do, some don't) and cause chunks of it to break free into your blood circulation and can add to your blockages worsening your symptoms and sometimes it is bad enough to have to rush a patient into heart surgery immediately. And, it happens often enough that angiograms are only performed at hospitals capable of performing emergency bypass surgeries, CABG's, etc., where you are always required to sign a release giving them permission to operate immediately if you should lose consciousness from the "a problem". 1 out of every thousand patients will die from this allegedly innoculous procedure! If your doctor has already explained this to you, pat yourself on the back. Many doctors do not. Many performed angiograms could and (IMO) have been done with the much less expensive and much safer non-invasive ultrasound procedures. Again, the patient has to ask (firmly) for these non-invasive options and be prepared to assert your patient's right to say "No" if your doctor should insist otherwise. Best advise: Go the www.vasomedical.com and learn what you can about EECP. If it makes sense to you, tell your doctor you'd like to try it. He'll most likely oblige you. It's safer than anything else I know of and it costs less than the sales tax for a bypass operation. Feel free to contact me personally at my email address: postman23_2000@yahoo.com
Gerald Oros, OrosCo Product Specialties, Collinsville, IL, November 30, 2005

• There is not much info you are providing to provide a clear answer. The worse case scenerio would be that you are covered by an HMO which owns and operates the facility and have decided they cannot provide a life extending procedure and recoup the cost. This could mean you are elderly and/or have other problems which will lead to continuous care at their expense. Of course this would be absurd, but to some, who may not understand, I am sure this thought has crossed many minds. Or, your arteries are too small, too frail, inoperable or too high a risk for either procedure, where they feel not intervening will give you a better chance to live longer. I would not assume the worse, since the doctor bothered to go in, it is most likely he is telling the truth. I know people in their 50's that have some branches completely blocked and are doing fine. Your heart will be, is, or has been providing "collaterals" to supply the portion of heart tissue that is being blocked off. I have 15 stents in my chest, and probably because my arteries and branches are pretty huge. I also have many collaterals. Excercise is probably your best bet now, but ask your doc. Good Luck.
RayZ, San Diego CA, November 28, 2005

• I have a 95% blockage of the LAD and an 80% blockage of the diagonal branch. The doctor told me that he couldn't find a small enough stent to insert in the arteries so he didn"t complete the event. My cardiologist agreed and he also said bypass surgery would be too extreme. Something is wrong here. What do you think? Help! I have no pain and I perform most work except running, etc. I think I need stenting or bypass
Carl Laurino, Valley Stream, NY, September 02, 2005

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