100% blocked coronary artery- treatment? dangers? what happens next?

[Luzon1]

I’m a 59 year old man from the South Jersey region.  I got my first Cypher drug-eluting stent on November 30, 2005.  At that time, I had another coronary artery (the left anterior descending, I think) that was partially blocked but did not require a stent as it was just above the “cut-off line”- it was 60 to 70% blocked.  The doctor performing the cardiac cath decided not to put the second stent in, opting to wait instead.  About five months ago, I developed a large inguinal hernia which prompted me to see a hernia repair specialist.  He told me he needed a clearance letter from my cardiologist before he could perform surgery.  So, I went to my cardiologist, and took a stress test and EKG this past April.  My cardiologist told me that my heart function dropped from 57% to 45% since my last stress test on Jan. 27, 2006 and that I now needed a stent in the artery that they had decided back in 05 to wait on.  

I went to get my second cardiac catheterization done at the beginning of this May.  I found out then that the un-stented artery is now 100% blocked.  But the doctor performing the surgery did not place the stent at that time.  He told me that I could get my hernia repair done first (even though my cardiologist and my hernia surgeon both agreed to take care of the heart first.  Apparently, I had “underexaggerated” my angina symptoms and “overexaggerated” my hernia symptoms, and this confused the doctor performing the cardiac cath.  I guess I was nervous or something—who wouldn’t be?—and didn’t answer the questions right.  I only mentioned the hernia so that he’d know where it was and wouldn’t rupture it or something.  I’m not a doctor, and don’t know about this stuff.  I still don’t understand why he didn’t just put the stent in anyway, previously this month.  Obviously, an artery that’s 100% blocked is well past the “cut off line.”  I thought that that was how this cardiology group worked—sort of by the book, as in the first stenting procedure.)  

So, about a week later, I told them I wanted to get the stent (as was previously agreed) before my hernia surgery, anyway.  The hernia doctor told me it could wait at least 6 months.  Now, I’m going back to the hospital next week to redo the cardiac cath (this will be my third cardiac cath since the first in 05) and hopefully get that second stent.  However, I just found out yesterday that the doctor performing the cardiac cath/stent procedure may not actually even be able to put a stent in because of some “lesion.”  I think what this means is that if the artery has calcified too much, the doctor can’t break through the extremely hardened plaque and, therefore, can’t place the stent.

Here are my questions:

1- If the plaque has hardened significantly, is there a way to break through the hardened plaque using some kind of special instrument, like a drill or tiny blade?  I’m wondering if this hospital is even equipped with those instruments.

2- How dangerous is it to leave the artery as is—100% blocked?  I have some collaterals but they probably aren’t enough (I still have angina).  I thought that once an artery is completely blocked, a patient suffers a heart attack.  I haven’t had a heart attack yet and hopefully never will, but with this 100% blocked artery, I’m unsure.  What is my percentage of having a heart attack with this fully blocked artery?

3- I think I read somewhere that with a fully blocked artery that can’t be stented, the next procedure performed is bypass.  That seems awfully dangerous in and of itself.  And I can’t keep running back and forth to doctors and hospitals.  My wife is severely disabled and obese.  I’ve been her sole caregiver for eleven years.  We have a daughter who is 21 and she has been helping me with the chores and caregiving, but my family still needs me around.  Would I have to get bypass surgery with this fully blocked artery, or would it be better to just leave the blockage as is, continuing my medication regimen?  (Plavix, BP meds, cholesterol meds, etc)

4- Can they even put a stent in an artery that’s 100% blocked—and if not, what does happen next?

5- Does anyone know of good hospitals in the Philadelphia/South Jersey region?  The hospital where my cardiologists work is notorious around here for doing less- than-reputable work.  I’m trying to find the best cardiologists and hospitals in this area and if anyone has any suggestions, I’m all ears.

Thank you very much for your time and answers to my questions.  This whole dilemma has really wrecked me and my family’s emotional well-being, as you can imagine.  I just wish the doctor performing the cardiac cath had put both stents in back in 05 instead of waiting this long for one of my arteries to become completely blocked and then suddenly telling me 1) I need that second stent afterall, and 2) he may not even be able to fix the problem because of lesions and calcification and a 100% blockage and what not.  I told the doctors that I couldn’t keep going through procedure after procedure because of my wife’s disability—apparently they didn’t listen to that one.

[Flycaster305]

What a nightmare situation.  I learned today from a stress test that it is suspected I have blockages in stents installed in 2006 plus a blockage that couldn't be stented in 2006 may be 100% blocked, and due to its location and size and shape bypass is out of the question. I've gone from daily aerobics and three times a week weight work to not being able to mow the lawn in a month.   I go in for an Angiogram tomorrow morning to see just what is going on.  Good show getting your question posted, I'm really interested in the answer from the doctor.  Best wishes.    

[Luzon1]

That sounds like a nightmare situation, too.  If possible, keep me posted on your situation and what the doctor says are your options from this point.  Good luck.