70% Artery Blockage !

[Fariha89]

Hi,
My uncle just had a angioplasty & it went fine he was there in the icu for 48 hours then he was sent home. After 4 days he had a heart attack again because there were some blood clots blocking the artery which were removed when he was taken to the hospital the second time. He was then there in the hospital for 12 days because they were givin him blood thining medications. He came home after that now hes taking some blood thining medications, omega3 fish oil tablets, taking care of his diet but still has chest pain.
He recently went to see the doctor & they found out that he has 70% blockage in one artery & 20% in one. After this detail I just wana ask can medicines cure 70 % blockage ? Or should we go for another angioplasty or is there any other solution ?
Thank You !
Fariha from Pakistan

[ed34]

not at all, you just monitor your condition and report to the emergency room if you feel quite bad. As a blockage increases, you start to feel symptoms get stronger. It is not like an on/off switch where one minute you feel fine and the next you have a heart attack. You may require more stents in the future, but your risk for heart attack is no higher than anyone else.

[grandmother54]

I am a 54 year old female and  Had 100% blockage to my left artery and 70 % to two more on 10/15/205. a  stent was put in for the 100% blockage and they told me i need a bypass and then they change there mind. am i at risk for another heart attack.

[sanatogen]

Thank you.
They did use drug eluting stents for my husband too.

[ed34]

In the UK it is standard practice to graft 2 vessels to a LAD, a LIMA/RIMA and a vein. The LIMA was grafted to my LAD but the surgeon put it directly over the plaque, the cause of the problem itself. When they graft a vessel they perform a small arterectomy as standard, so he dug a small trough in the plaque. Of course, the LIMA was trying to give blood to the LAD but it had nowhere to go because it was grafted in the middle of the blockage. They did consider moving the LIMA further down the LAD but it was trimmed too short and wouldn't reach that far. They then considered harvesting my RIMA, but the level of plaque coating my LAD all the way down made it unlikely the bypass would work for long.
Blocked stents are when restenosis occurs. Depending on the type of stent in use, this could be in the form of a clot, scar tissue or even plaque. They can generally be reopened by inserting a second stent inside the first one. This is usually done if the first one was a bare metal stent and they deploy a drug eluting stent inside that one in the hope it will help recovery. I don't believe this method is successful in everyone. Stents can of course fracture or completely collapse but this is rare. The most common cause of restenosis of a stent is the excessive growth of scar tissue which promotes either clotting or more plaque. This is why the drug eluting stent was developed. It is coated with chemicals which slow down scar tissue formation, but still allow normal growth of healthy cells to make a new lining. Newer stents are in development which are biodegrading. After a few months, they will have broken down into  microscopic particles and be removed from the body entirely.

[sanatogen]

I wonder why could they not use an arterial graft in your case( say, internal mammary artery) instead a venous graft?   An arterial graft, as I heard is lot stronger and a near permanent solution.
I know a couple of friends who had By-Pass surgery in past with the use of int.mam.artery
graft and NO history of collapse vessel in last 20years.

Could you please also enlighten me regarding "stent block".   Suppose, a stent gets blocked.... and the patient gets symptoms...  Would they go through the angiogram  again
to diagnose the block?   OR,  do they diagnose it by a CT scan?  

What procedure do they use to repair a blocked stent??   Any idea of the success rate?

Thanks.

[ed34]

In the UK you can purchase a copy of a CD whereas any Doctor can request one free of charge. However, the CD is really out of date from the moment the procedure is finished.
You could liken it to a video of a car having a nice new paint job. Once the car leaves the paint shop there is only guess work as to what condition the car is in.

[ed34]

CABG is no longer an option. Due to the fact that my veins collapsed after just three months I fall into the catagory of cabg intolerant. My Lima is already grafted to the proximal section of LAD and is now too short to put lower down. With long stents end to end in the LAD I can't see how they could graft a vessel to it anyway? An arterectomy incision would have to be very long to try and remove one of the stents and with tissue growth through the scaffolding I would have thought this would tear it to shreds. I still have a feeling it's the proximal section giving problems and I just hope a ct scan will show up as accurately as an angiogram.

[oldie]

When you watched the CD did you see small puffs or clouds or what seem in mine to be the contrast dye leaking out of the artery at the point the stent was placed?. I called the cardiologist after watching my CD and asked if my artery was punctured. He said there was nothing abnormal to worry about. But I still feel doubtful.  I would be grateful to hear from you.

[kenkeith]

You may be a very good candidate for EECP.  My CT scan report states the blood flow out of the stented vessel (RCA) appears to be adequate.  You have many stents end to end on one vessel and that may be difficult to find which stent has partially collapsed or occluded.  Do you think CBAG is the only option under those circumstances if the blood flow out of the last stent has diminished?

[ed34]

I really don't think my lad is suffering spasms. I feel now exactly as I did before the procedure which makes me believe a severe restriction has formed in the proximal lad, forcing my collaterals open again. This is why I will be insisting on a CT scan when I see my Cardiologist next month. I doubt if disease is the cause, but I do have concerns over maybe a stent collapsing or the accidental dissection of the artery causing a problem. From my symptoms and recognising them all as being the same as when my bypass failed, I am 99% sure this is what has happened. It will be interesting to see if I know my own body as much as I hope I do.

[kenkeith]

Thanks.  Makes sense, sorry for the complications of your cardiovascular condition..

[ed34]

This is how cardiologists explained the situation of collaterals in my case.

In most cases where collaterals have formed, patients suffer angina with variant degrees upon exertion and have to be treated with medication, which sometimes helps but not always. This means, whether on medication or not, the truth is there isn't a sufficient flow through the collaterals to heart tissue. Apparently when I had bypass surgery, the collaterals closed down, due to the higher flow and pressure back in the LAD. Now remembering in my case the Lima was grafted over the blockage, making it useless, I basically was left with a single grafted vein supplying the LAD. When this shut down, I had no collateral feeds or any feed to the lower left side of the heart. Apparently that's why I collapsed to the ground gasping for air for around 10-15 mins. Then suddenly things seemed to improve a great deal and I was able to stand up and walk home. They explained that those collaterals opened up again, giving a supply to the starved area. Now the LAD blockage is removed, the collaterals will be closed up again.
That's how they explained it to me. My question now however is what happens with 2 feeds into the LAD. My Lima is now patent and feeding into the proximal LAD, and there is a normal feed through the left main stem into the LAD. I would have thought that one is higher in oxygen concentration than the other. Is there more flow for the LAD to cope with? too much?

[Fariha89]

Thank you for the link.

[Fariha89]

We got a cd from the doctore where we can see him doin the whole procedure in my uncle's body if you got any from your doctor tell him to see that cd because sometimes durin the stentin procedure your heart gets a little damaged which causes pain in your chest.
Yes, inshAllah you & my uncle will be fine =)
Stay blessed & healthy.

[kenkeith]

Has consideration been given to the fact that a totally occluded vessel will be fatal unless there is/has been a supply of blood to the deficit area?  And if and because there has been an on going slow process of plaque buildup there has to be another source for the blood supply to the subject area if buildup of plaque is at critical location to avoid an MI or as the plaque is building up there are progressively small areas of the heart that become necrotic from lack of oxygenated blood. It seems reasonable that to open a totally occluded vessel will reduce the blood pressure at proximal side of the occlusion that drives the alternative source of blood that now had been supplying previous area of the blocked vessel.  Do you think there is a possibility that under the circumstance of opening a totally blocked vessel will not now provide an adequate blood supply to the area, and the collateral vessels will also be rendered ineffactive from reduced pressures?

[ed34]

That depends on the easiest approach. In most cases it would have to be the proximal side, ie nearest the source of flow. In my case it was believed there were 2 possible approaches to removing the blockage. 1 was to enter through the Lima which would have resulted in being in a tiny clear trough in the middle of a blockage 2cm either side. However, it was decided that the angle at the anastomosis was too great. Access from the left main stem was the final decision. Rotablation of total occlusions in coronary arteries in St. Marys hospital London are very common, as is the use of laser. However, there has to be a lot of consideration regarding the anatomy of the blockage. Considering a catheter guidewire has to be passed centrally through the blockage to prevent wall damage from the drill, the blockage has to be on a fairly straight section and has to be quite short so the other side can easily be observed. There is also a bigger problem if the blockage is tight against a bifurcation. Mine was about 5mm in from the bifurcation of lad/circumflex.
In St. Marys the use of angioplasty over bypass is increasing all the time due to long term outcomes and trauma.
Actually the procedure used on my blockage was quite intriguing but also nerve wrecking to watch. You seem to be engrossed in the process, but keep reminding yourself "hang on, this is inside me, one slip and I will die". They had to chip away at the hard cap on the end of the occlusion for about 20 mins before hitting soft plaque, so the guidewire could be pushed through. Each tiny piece of plaque was patiently removed from my body which is why it took so long. Once the rotablator went in, whoosh, it seemed to zoom through destroying everything in its path. A tiny net was opened at the end of the guidewire to be a safety net, catching any possible large pieces. However, no large pieces escaped the drill.
The remainder of the LAD had a substantial coating of plaque and they ran a laser up and down a few times, cleaning it. I passed out from extra medication at that time, but kept waking up to pains when the balloon was inflated. Boy did that hurt. I lost count how many times they used the balloon, but it was for the entire length of the lad.

[kenkeith]

Quote:  "Even a 100% blockage can be stented".

>>>>Is that angioplasty approaching from the distal side of the occlusion?  

[larry71]

For Fariah and everybod's info,

you can read and download lot of materials from the below link....especially having a healthy diet for people with heart related disorders ....

http://www.bhf.org.uk/living_with_a_heart_condition/top_bhf_publications.aspx

[ed34]

I am shocked that he had a clot form in the stented area. Was it a drug eluting stent and was he on plavix with aspirin?
A 70% blockage can certainly be stented, in fact, as Kenkeith stated, this is the minimum before stenting is even considered. Even a 100% blockage can be stented.
A bypass does not remove all blockages. In fact, the blockages remain where they are and extra blood vessels are stitched in the area past the blockage. This is why it's called a bypass and not a removal.

[ChatterAlly]

I have had 3 stents put in the RCA and still suffer with chest pains.  I never had these chest pains before the stents.  I had some discomfort and shortness of breath that sent me to the ER in 2004.  That's when the first stent was put in and I started having the chest pains that I have now. Since then I have had 2 confirmed heart attacks.  Recently I was diagnosed with coronary artery spasms and was told I had a 50% blockage that would require bypass if the chest pains didn't get any better.  I am trying the meds first.  I will have the bypass only as a last resort. I am now on the beta blocker, ace inhibitor, calcium channel blocker, statin & 2 forms of nitrates.  Let's hope that your uncle and I can get some relief without all that bypass misery.  Take care, Ally

[Fariha89]

Thank you so much sir for the diet link I'll show that to my uncle.
Yes, even am shocked to hear that & same is the case with my father now he has controled his diet & takin medicines so Allhumdulilah hes fine now.=)

[kenkeith]

I never had a weight problem, nor has my cholesteral been very high, no family history of a heart problem, etc. so I was shocked to learn I had had a silent heart attack and was now in congested heart failure mode (6 years ago). I had an enlarged left ventricle, totally blocked LAD (has collateral vessels), RCA was 98% blocked and stented, a 72% blocked circumflex (no stent), and an EF 13 to 29%. Currently my heart is normal size and pumping normally, and I have not had 1 day of feeling ill...not even a headcold, but I do have moderate to severe mitral valve regurgitation (no symptoms).

My current medication is an ACE iinhibitor and beta blocker to manage blood pressure.  When I go for a workout (weights and treadmill) I take a nitrate 3 times a week. My doctor (non interventional) suggested if I was interested in EECP therapy for angina that would be available.  There has been some success with that procedure (about 80%), and I wouldn't need to take a nitrate pill if the therapy is successful.  That therapy is a non invasive procedure, and may be appropriate for some pts.

I have provided a link that informs interested individuals for a heart healthy diet that may interest you.
http://www.mayoclinic.com/health/heart-healthy-diet/nu00196

[Fariha89]

Sir,
You've gone through the same thing so am gona ask you about your deit. What changes did you make & what did you eat for few months when you had angioplasty ? Because I think walking & maintaining your diet is very important.
& also let me know which cookin oil you use olive oil, regular vegetable oil (but in small quantity) or some other oil ?
Thank you.

[Fariha89]

Thank you so much guys !  
Yes, he also take Nitro pill & they have inserted a stent in on of his artery when he first went then he was sent home but had a heart attack again because the clot blocked the stent area so they inserted the balloon to suck all the clots. @ Kenkeith  

Hes 54 & I'll let you know if he thinks of gettin a by pass @ Amalesward

Thanks again both of you.