100% LAD blockage

[gmel]

My husband (age 60) had a heart attack a few months ago and he has a 100% blockage in the LAD and a 80% blockage in the RAMUS.

He has no symptoms...no pain etc.  He had stable angina before the heart attack but none now.  His ejection fraction is 50-55%.

Weight is normal.  Cholesterol is good.  Blood pressure is 110/70.

His doctor tried angioplasty on him but without success.  He said "bypass asap because your heart needs oxygen.  You have silent ischemia."

My question is this:

If someone is alive after a 100% LAD blockage doesn't that mean that there are a good number of collateral arteries helping out?

How does a doctor determine that someone needs bypass surgery?  I'm asking because he's afraid, doesn't have any symptoms etc.  I'm also reading about people who have such blockages and are living with them.

He isn't against bypass surgery.  He's just wondering. (He doesn't speak English very well..so that's why I'm writing this.)

[Flycaster305]

You have asked an interesting question, and I'll bet you get a variety of answers.

I'm not a health professional, but have had four blockages in the LAD.  I have one in a small branch right now that has given me fits with chest pain, but the artery is too small and twisted to approach with angioplasty or a stent.  

Is there a teaching hospital in your area that could offer a second opinion?  The record of the angioplasty could be sent for a second set of eyes.  I've used that approach in the past.

Collateral arteries usually form after an MI, sometimes aggressive drug therapy combined with exercise and diet changes works wonders.  On the other hand, I had poor luck developing collateral arteries even though I've been quite aggressive with drug, exercise and diet changes.  I've not had bypass, stents have worked except with those little branch arteries.

I'd get a second opinion.

[Cleveland Clinic]

We perform interventions for two reasons: to minimize symptoms and to decrease death. Since he has no symptoms it is hard to argue about the first point. So is there a benefit to opening up an LAD, which is 100% blocked. It depends, as there are no trials designed to look specifically at this. Certainly if he had decreased EF, which he does not. But he may have large amounts of ischemia with stress and either no symptoms or atypical symptoms of ischemia. If a stress test showed this then this would be a cause for intervention, but once again because of symptoms. I don't think that there is any clear evidence to say that having a LIMA to the distal part of an LAD, in the absence of large amounts of ischemia, will actually prolongue life to a greater amount  than the detriment of open heart surgery imparts on most patients.