• 26 days ago

    99 - 100% blockage in LAD artery

    I'm a little concerned about the results of a heart catherization I had about 10 days ago. It showed 99-100% blockage in the LAD artery, and 70-80 % in the rest. At that point the doctor was very concerned, and asked me several times if I was sure I didn't have a heart attack. He discussed the options with me, stents or bypass surgery. He recommended bypass surgery. He sent me to a surgeon, who questioned my ability to handle surgery, given he may not be able to get a good vein out of my leg. He was suppose to call back today after presenting it to his committee, but he never called. The surgeon has a very cavilier attitude about my health. Any suggestions?

Responses

  • RE: 99 - 100% blockage in LAD artery

    Hello,

    "He discussed the options with me, stents or bypass surgery. He recommended bypass surgery."

    On an individualized case-by-case basis, sometimes, bypass (CABG) surgery is the most viable/logical option and other times catheter-based coronary stenting is.

    While bypass surgery can be a much more thorough treatment, especially in the case of diffuse (long areas of the arterial wall is affected) disease, some experts consider stents as just a Band-aid or spot treatment, however others disagree with that description, since stents have come quite a long way now in development with drug-elution, that typically prevents/eliminates or substantially reduces the chance of having any restenosis occur, which is a build-up of scar tissue at the stented site(s).

    From the WebMD Archives (Circa 2011) BUT still relevant today!

    For Multiple Heart Blockages, Bypass Surgery or Stents?

    Study Compares Pain, Quality of Life After Drug-Coated Stents or Coronary Artery Bypass Surgery

    ......a large clinical trial suggests that drug-coated stents, springy lattice tubes used to prop open clogged arteries, may also work well in patients with multiple blockages. And in some patients, the stents produce equally good results with faster recovery times......

    https://www.webmd.com/heart-disease/news/20110316/for-multiple-heart-blockages-bypass-surgery-or-stents#1


    "He sent me to a surgeon, who questioned my ability to handle surgery, given he may not be able to get a good vein out of my leg."

    Clinical studies (some large-scale) have shown that, depending on the type of graft used, the individual himself or herself/individualized factors, bypass grafts may/can last from 10-15 years or longer.

    HOWEVER, in some instances, grafts may/can fail early/prematurely (e.g., 1, 2 or 3 years) or even fail right after or shortly after the surgical procedure is completed.

    Common venous grafts are the greater saphenous veins (GSVs) in the leg(s), which are accustomed to low pressure. Common arterial (accustomed to high pressure and are more resistant to atherosclerosis) grafts are internal mammary or thoracic arteries (in the chest, most common is the left as opposed to the right, sometimes both can be used) and radial arteries (in the arm). Uncommon graft conduits include the right gastroepiploic artery, the inferior epigastric artery and the subscapular artery.

    Saphenous vein graft (SVG) failure after bypass surgery may be a high as 5%-10% in the first post-operative week. Disruption of graft endothelium correlates with early graft failure. The cardiothoracic surgeon should take measures during the surgery to avoid endothelial injury to the vein graft.

    Symptoms of a failed or collapsed bypass graft, include that of a blocked native coronary artery, which can include (when there is no, or insufficient collaterals, backup or rescue vessels) heart attack, myocardial infarction (MI, actual death or necrosis of heart muscle), which in turn can gradually, or quickly/suddenly (acutely) lead to heart failure/congestive heart failure, and sometimes sudden cardiac death (SCD).

    If/when common procedures, first time or re-do, such as bypass or angioplasty, with or without stents, are not deemed feasible, there may/can be other options that includes non-invasive EECP, laser-based TMR or PMR/PMC, and gene therapy/transfer.

    "The surgeon has a very cavilier attitude about my health. Any suggestions?"

    Do feel free to seek a second professional medical opinion. ALWAYS be proactive in your health care and treatment. Sometimes this requires being assertive.

    Take care,

    CardioStar*

    WebMD Member (since 8/99)
  • 19 days ago

    RE: 99 - 100% blockage in LAD artery

    With a blockage like that, they should have never even let you drive home. You should have been kept at the hospital for monitoring. Keep calling and I don't care if you need to lie, say you feel faint, and go BACK to the hospital, until they can figure out the best course of action. And if you don't have insurance, that sucks, but medical bills aren't worth your life.