Angioplasty and percentage of block in the arteries

[Raj1o1]

Tests have shown that I have one 70% block in the left artery. One doctor has recommended that I should get an angioplasty. However, I am going for a second opinion. My question is what is the right time (in terms of %age of block) to do angioplasty. I have heard that doctors do not recommend angioplasty till the block grows to 90% or more.
What is your opinion and advice?

[ed34]

"as there is evidence of doing unnecessary angioplasty for the profit involved"

Luckily there is no profit in our health service.

The risks you list are tiny in comparison to the number of successful stents implanted around the world. Why haven't you included a risk list of the dangers of leaving a blockage? or do you feel this unnecessary?

[kenkeith]

I agree with Chatter and would add:

There are two schools of thought with the medically trained cardiologists in the USA.  There is the non-interventional cardilogist and the internventional cardiologist.  I had the experience of having a interventional cardiologist who did an angiogram and stented my 98% blocked RCA and did not stent the 70% blocked ICX.  A few months later he wanted to do a stent implant on the ICX, and I asked why as I had no symptoms? (this was a time with no knowledge of heart health issues)...He did not give me an answer, a few weeks later he moved his practice to Florida, whatever.  

My current and for the last 7 years is a non-interventional cardiologist who has never mentioned doing a stent implant, but indicated a possible bypass in the future for the 100% blocked LAD and a valve replacement. He stated if I were to have a valve replacement, the bypass would be done at the same time.  I don't totally agree with that evaluation, and I would rely on a SURGEON from Mayo Clinic for any surgical opinions.

Because there are two schools of thought that have credibility, it may be a good idea to consult a non-interventional cardiologist for a second opinion for marginal occlusions, whatever, as there is evidence of doing unnecessary angioplasty for the profit involved.  

Which doctor provides the better therapy for an occlusion?  In retrospect, it appears the stent implant was/is unnecessary according to my current cardiologist.  The current non interventional cardiologist believes in a more heart healthy diet, exercise, a moderate life style,etc. and following the doctor's advice my heart has returned to normal size and the EF is normal.

Rcently, there has been a post where the doctor doing an angiogram perforated the patient's vessel with a cath, then there is the risk of restenosis (clot) that can be fatal or cause another stent implant or bypass, there can migration of the stent (then what?), there can be a collapse of defective stent (what then), the risk of a stent not being the right size (then what?)  If medication provides good blood flow based on tests and no symptoms, what would be the problem with that result?  If the previous stable angina has been treated with medication, and unstable angina develops...then a stent implant may be  appropriate from my point of view, if ever necessary. But that is for a doctor and patient to decide.



  

[ed34]

I think it's important to look ahead, rather than just concentrating on today. Many blockages do worsen and the worse they become, the harder they become to treat. So, if I had a 70% blockage which could be stented now, I wouldn't wait until it became more difficult to treat, requiring more risky surgery. As blockages increase, symptoms increase, and you have to pump even more pills into your body to overcome this. At what point do you say "ok, let's get this sorted"? I think the fear factor is a big issue with decisions made by patients. The fear of having surgery or any intervention. It seems so much easier to handle pills if you can. I can understand that because I needed a stent immediately to save my life, and I was scared sh****. If I had a choice at the time for meds or stent, I would have undoubtably picked meds because of the fear. But, in most cases, the pills just delay the inevitable, the disease grows if not brought under control by strict lifestyle changes.
Do you find fear is a factor in your decision making?

[ChatterAlly]

Yes, Ed, I do remember!  Poor bear.  Only doing what comes natural in his own habitat.  Can we stick to the posted question here?  Intervention, in my opinion, is still a decision that only the patient should make.  What would you do?  If it is 70% blocked and there is a lot of crippling symptoms with this, I would not think twice about intervention.  I am dealing with a blockage now that is causing quite a bit of chest pain, but has not caused me to become incapacitated yet.  This blockage will require bypass.  As long as I can get by with meds without intervention, then this is how I choose to treat it. On the other hand, even being a single vessel intervention, if it does become troubling, what choice would I have?  Again, it is a judgement call that only the patient can make with an accurate and well educated diagnosis. If your doctor feels that intervention is needed and you trust this doctor, what choice would you make?

[ed34]

so all cardiologists/surgeons should change what they say to patients who have received life threatening surgery. Expected to die, they are intervened to save their lives. So the next day in the ward on his rounds the experts should say "sorry, your longevity has not been increased, you will still die yesterday". I remember telling you this before, I was told one more attack would very likely be my last. I had to go in an ambulance for over 20 miles for emergency stenting. Are you saying this didn't improve my longevity? because without it I would have died on 12th feb 2007.

"sing a handbag"  what!  I hope you mean sWing a handbag. It's an analogy of two old women squabbling over something. Handbags are much less violent though, nobody was killed :)  You do know that in the US a few years back a man was being attacked by a bear and his wife chased it off, hitting it with an umbrella. Everyone survived, including the bear.

[kenkeith]

You know what I meant as it has been said many times. I do mean life expectancy.  Why are you beginning to be testy? (something like that woman from UK that was swinging her handbag and chased off 3-4 individuals trying to smash and grab from a broken window!!  Seen on TV.:) An anology you have made several times..sing a handbag..Is that a UK thing with gun control or something.

I can document what I say...what is the basis of your opinion and lets maintain some useful exchange of information.  If it just your opinion, that is OK. This discussion as been made many times, if you can't believe or you are familiar with something different...you should share, and I will offer another side...if there is another side. You are not a doctor, nor am I, but we both can read or in you case what a doctor said as well?.  That is hearsay, and not very good or useful information, because the "doctor" isn't available to make a clear understanding with relevant questions on the subject,,.your information gained by what a doctor states may be misunderstood!  Who knows?  

Thanks for your comments.  But I am not going to have my partially blocked ICX artery stented when there are no symptoms with medication for an expectation I will have a longer life span. Others can do as they feel is in their best interest but offering another side is not nonsense.

Thanks for your comment.

[ed34]

"and does not increase one's longivity"

By longevity in this context I assume you want it to mean life expectancy? In which case, that's total nonsense.

[ChatterAlly]

In most cases the protocol is any blockage 70% or greater needs intervention. In my opinion a stent is necessary. I have had too many peripheral and cardiac caths with intervention to count anymore.  If a stent is needed I am for it.  But in addition to this I have made lifestyle changes to aid in my nealth. If a second opinion makes you rest easier there is nothing wrong with that either. Trust your own judgement and make the decision you feel is right for you. Take care and keep us posted as to what you decide. Ally

[kenkeith]

The AHA/ACC have guidelines that recommend of stenting occlusions greater than 70%, if the symptoms (usually chest pains) can not be controlled with medication.  I have a lesion on my ICX that is about 70% or so for the past 7 years or more. Treatment with medication, stent or bypass only treat the symptoms and does not increase one's longivity.  If and when my ICX cause uncontrolled angina (chest pain), then a stent.  Just recently a television doctor stated intervention is oftened unnescessary.  He used an example where one tennis player interrupted his game and took a nitro pill and continued playing.

I wouldn't even consider a stent for my ICX occlusion...what would be the point?

Thanks for your  question and sharing your medical concern.  If you have any further questions or comments you are welcome to respond.  Take care

Regards,
Ken

[LindaTX]

My Dr said that anything over 65-70% requires stenting.