Aa
My Rotablation yesterday
Just to keep you informed. I arrived at Imperial College London to have the occlusion in my LAD removed but
unfortunately an ECG highlighted a problem. I had been experiencing a strange twitching in my chest for about a week
but assumed it was palpitations. It was due to my Heart being slightly out of rhythm and classed as too dangerous
for my procedure. I was given a mixture of injections and my heart is now synchronised again. I will be re-booked for
next week if it stays in good order. They felt that the synch problem was due to the lack of blood flow to the front of
the heart. So, fingers crossed for next week now. Oh, just to add, the procedure has now been calculated at 1% risk
which is very good indeed. There is a queue of other cardiologists waiting to observe the procedure.
unfortunately an ECG highlighted a problem. I had been experiencing a strange twitching in my chest for about a week
but assumed it was palpitations. It was due to my Heart being slightly out of rhythm and classed as too dangerous
for my procedure. I was given a mixture of injections and my heart is now synchronised again. I will be re-booked for
next week if it stays in good order. They felt that the synch problem was due to the lack of blood flow to the front of
the heart. So, fingers crossed for next week now. Oh, just to add, the procedure has now been calculated at 1% risk
which is very good indeed. There is a queue of other cardiologists waiting to observe the procedure.
"I had the understanding you had had an MI and collateral vessel development. It the opinion to open a totally blocked occlusion that has developed collaterals over a period of time that I refer. "
The occurrences of MI I experienced were not due to the LAD at all. It was the Obtuse
Marginal which was blocked that caused the MI. The developed collaterals were from the RCA to LAD. Due to the MI being responded to very quickly, there was no ireversible tissue damage to the Heart, several nuclear tests have proved this. As you know, MI CAN lead to heart muscle damage or death, but is not always the case. It is simply the
PROCESS that leads to necrosis.
"Its not clear what you are talkjing about regarding 1% risk. My souce is as follows and it clearly shows a much greater risk when considering a more inclusive risk, and includes on-ite backup and no backup"
I have only stated what was put on the consent form for the procedure. The Cardiologist
who performed my procedure has 30 years exerience in angioplasty. Perhaps you would
like me to send you his name etc so you can write to him?
The occurrences of MI I experienced were not due to the LAD at all. It was the Obtuse
Marginal which was blocked that caused the MI. The developed collaterals were from the RCA to LAD. Due to the MI being responded to very quickly, there was no ireversible tissue damage to the Heart, several nuclear tests have proved this. As you know, MI CAN lead to heart muscle damage or death, but is not always the case. It is simply the
PROCESS that leads to necrosis.
"Its not clear what you are talkjing about regarding 1% risk. My souce is as follows and it clearly shows a much greater risk when considering a more inclusive risk, and includes on-ite backup and no backup"
I have only stated what was put on the consent form for the procedure. The Cardiologist
who performed my procedure has 30 years exerience in angioplasty. Perhaps you would
like me to send you his name etc so you can write to him?
QUOTE: "Oh, just to add, the procedure has now been calculated at 1% risk".
>>Its not clear what you are talkjing about regarding 1% risk. My souce is as follows and it clearly shows a much greater risk when considering a more inclusive risk, and includes on-ite backup and no backup.:
Posted on June 23, 2009
VASCULAR MEDICINE/INTERVENTION ...The study compares on-site support with no-site cardiac support and found no major differences in procedural success, mortality in PCI centers without on-site cardiac surgery. Institutions that performed percutaneous coronary intervention with no on-site cardiac surgery had PROCEDURAL SUCCESS and mortality similar to institutions with on-site cardiac surgery.
The analysis cohort consisted of 308,161 patients from the National Cardiovascular Data Registry (NCDR) CathPCI Registry entered between January 2006 and March 2008. Of those, 8,736 patients underwent PCI at 60 institutions with no on-site surgical back-up, with the remaining 299,425 patients undergoing PCI at 405 institutions with surgical back-up. The analysis endpoints were incidence of emergency surgery and in-hospital death from all causes following PCI.
The results, published in yesterday's Journal of the American College of Cardiology, suggested that off-site facilities had a marginally higher aggregate procedural success rate (94% vs. 93%, P=.010). Aggregate total complication rates were also similar for off-site vs. on-site facilities (6.5% vs. 6.3%), although off-site facilities reported more bleeding events while on-site facilities reported more vascular complications. Off-site facilities reported fewer total complications in primary PCI compared with on-site facilities (11.6% vs. 13.4%, P=.029), along with lower general (2.6% vs. 3.3%, P=.001) and vascular (0.8% vs. 1.1%, P=.017) complication rates in nonprimary PCI vs. on-site facilities. There were no differences in risk-adjusted mortality between on-site and off-site facilities, and there were higher risk-adjusted odds of emergency surgery in the on-site facilities (OR=0.60; 95% CI, 0.37-0.98).
Although the results suggested comparability between the two types of facilities, the researchers cautioned against radically altering practice based on the findings.
“These findings should not be extrapolated to encourage the widespread proliferation of more PCI programs without surgery on-site to fulfill a political or economic agenda,” the researchers concluded. “Rather, our study does confirm the safety of an off-site strategy at PCI centers where rigorous clinical, operator and institutional criteria are in place and where data are submitted and reviewed in a comprehensive, multicenter registry such as the NCDR.”
In 2008, Cardiology Today reported that the Society for Cardiovascular Angiography and Interventions released a consensus document on PCI at facilities without onsite surgery, but Gregory J. Dehmer, MD, SCAI president and chair of the panel that created the document, said SCAI does not encourage off-site PCI, but rather wanted to provide guidance for the widely practiced option.
For more information:
Kutcher MA. J Am Coll Cardiol. 2009;54:16-24.
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More About Vascular Medicine/Intervention · Intervention
_____________________________________________________
QUOTE:....."technique which involves making a hole through the side of a stent to open
up other vessel branches. This technique was very quickly rolled out through other hospitals world wide. I'm not sure how they do this but apparently it has been very successful so far with no problems"
>>I know very well the location of the occlusion referred to...my LAD is totally occluded and ICX is 72% and well developed collaterals by-pass the LAD blockage. Tho only way the occlusions can be stented would be a "Y" (on its side) formed stent. It seems to me perforating the side of a stent on the LAD to supply blood to the ICX would be problematic to say the least.
I had the understanding you had had an MI and collateral vessel development. It the opinion to open a totally blocked occlusion that has developed collaterals over a period of time that I refer.
>>Its not clear what you are talkjing about regarding 1% risk. My souce is as follows and it clearly shows a much greater risk when considering a more inclusive risk, and includes on-ite backup and no backup.:
Posted on June 23, 2009
VASCULAR MEDICINE/INTERVENTION ...The study compares on-site support with no-site cardiac support and found no major differences in procedural success, mortality in PCI centers without on-site cardiac surgery. Institutions that performed percutaneous coronary intervention with no on-site cardiac surgery had PROCEDURAL SUCCESS and mortality similar to institutions with on-site cardiac surgery.
The analysis cohort consisted of 308,161 patients from the National Cardiovascular Data Registry (NCDR) CathPCI Registry entered between January 2006 and March 2008. Of those, 8,736 patients underwent PCI at 60 institutions with no on-site surgical back-up, with the remaining 299,425 patients undergoing PCI at 405 institutions with surgical back-up. The analysis endpoints were incidence of emergency surgery and in-hospital death from all causes following PCI.
The results, published in yesterday's Journal of the American College of Cardiology, suggested that off-site facilities had a marginally higher aggregate procedural success rate (94% vs. 93%, P=.010). Aggregate total complication rates were also similar for off-site vs. on-site facilities (6.5% vs. 6.3%), although off-site facilities reported more bleeding events while on-site facilities reported more vascular complications. Off-site facilities reported fewer total complications in primary PCI compared with on-site facilities (11.6% vs. 13.4%, P=.029), along with lower general (2.6% vs. 3.3%, P=.001) and vascular (0.8% vs. 1.1%, P=.017) complication rates in nonprimary PCI vs. on-site facilities. There were no differences in risk-adjusted mortality between on-site and off-site facilities, and there were higher risk-adjusted odds of emergency surgery in the on-site facilities (OR=0.60; 95% CI, 0.37-0.98).
Although the results suggested comparability between the two types of facilities, the researchers cautioned against radically altering practice based on the findings.
“These findings should not be extrapolated to encourage the widespread proliferation of more PCI programs without surgery on-site to fulfill a political or economic agenda,” the researchers concluded. “Rather, our study does confirm the safety of an off-site strategy at PCI centers where rigorous clinical, operator and institutional criteria are in place and where data are submitted and reviewed in a comprehensive, multicenter registry such as the NCDR.”
In 2008, Cardiology Today reported that the Society for Cardiovascular Angiography and Interventions released a consensus document on PCI at facilities without onsite surgery, but Gregory J. Dehmer, MD, SCAI president and chair of the panel that created the document, said SCAI does not encourage off-site PCI, but rather wanted to provide guidance for the widely practiced option.
For more information:
Kutcher MA. J Am Coll Cardiol. 2009;54:16-24.
Like This Story? Get more e-mailed to you free!
More About Vascular Medicine/Intervention · Intervention
_____________________________________________________
QUOTE:....."technique which involves making a hole through the side of a stent to open
up other vessel branches. This technique was very quickly rolled out through other hospitals world wide. I'm not sure how they do this but apparently it has been very successful so far with no problems"
>>I know very well the location of the occlusion referred to...my LAD is totally occluded and ICX is 72% and well developed collaterals by-pass the LAD blockage. Tho only way the occlusions can be stented would be a "Y" (on its side) formed stent. It seems to me perforating the side of a stent on the LAD to supply blood to the ICX would be problematic to say the least.
I had the understanding you had had an MI and collateral vessel development. It the opinion to open a totally blocked occlusion that has developed collaterals over a period of time that I refer.
I was told by 19 cardiologists and three cardiac surgeons that the only reason a fully blocked artery is not re-opened is when the heart tissue has already died, because there
is no point. They do an angiogram and inject nitrates into the vessel to note any reaction
to the dilation. If the vessel does not respond, then it has lost the actual ability to open up, the muscle layer has basically died.
Let me explain what my LAD looks like on the Angiogram to give you a better idea of
what's going on.
If you imagine the left main stem coming in from the Aorta, this is clean and fully patent.
This is true even up to the Circumflex branch. Right next to the circumflex branch is where the total occlusion starts and is approx 35-40mm long. Halfway along the occlusion there is a 10mm 'trough' full of blood. This is where a bright spark surgeon decided was the best place to graft my Lima. Right in the centre of the occlusion, blocking that also. If you imagine my left main stem as being the thickness of a drinking straw so I can portray a scale to you. After the occlusion, right to the bottom, my LAD
becomes the size of a fine cotton strand. Cardiologists were confused as to where the
blood was coming from and it was running up the LAD instead of down. Very fine adaptations were discovered near the bottom, grown right round from the Circumflex.
This supply is just enough to keep the tissue alive at rest but any kind of exertion, even
standing up or eating causes an overload. The vessel has the ability to become patent,
nitrates injected into it have proved this. There is disease along the length of the LAD
but although distal, there is no concerning proximal disease. I believe if this was the
case then such a thin vessel would be blocked in several places. When the grafted
veins were open and the LAD was patent the difference I felt was undescribable. It's
just unfortunate it was so short lived. So I suppose technically, the occlusion in the
LAD is total because it's 40mm long with no possibility of blood being able to get passed
it, but through the adaptations the LAD is not closed. You have to really squint at the
angiogram to see the LAD and at first they thought it was completely closed up. With it
being so thin some cardiologists are amased I am still walking and breathing.
This is the main vessel supplying the largest area of the left ventricle and this is the most
important side of the heart. That's why they call it the widow maker.
There have been barriers throughout the last two years which have prevented this procedure, apart from finding a cardiologist with the confidence to perform it. For example, when the occlusion is removed, a very long stent will obviously have to be
fitted. Due to the occlusion being so close to the circumflex branch, it would mean the
stent covering the access to this vessel. The research college I am going to actually developed a technique which involves making a hole through the side of a stent to open
up other vessel branches. This technique was very quickly rolled out through other hospitals world wide. I'm not sure how they do this but apparently it has been very successful so far with no problems.
I have been assured I am not part of research of any kind but so far 8 cardiologists want to be present to watch this procedure be performed. Even if it was for research, I see it that if it works then it will open doors for millions of other patients if successful.
is no point. They do an angiogram and inject nitrates into the vessel to note any reaction
to the dilation. If the vessel does not respond, then it has lost the actual ability to open up, the muscle layer has basically died.
Let me explain what my LAD looks like on the Angiogram to give you a better idea of
what's going on.
If you imagine the left main stem coming in from the Aorta, this is clean and fully patent.
This is true even up to the Circumflex branch. Right next to the circumflex branch is where the total occlusion starts and is approx 35-40mm long. Halfway along the occlusion there is a 10mm 'trough' full of blood. This is where a bright spark surgeon decided was the best place to graft my Lima. Right in the centre of the occlusion, blocking that also. If you imagine my left main stem as being the thickness of a drinking straw so I can portray a scale to you. After the occlusion, right to the bottom, my LAD
becomes the size of a fine cotton strand. Cardiologists were confused as to where the
blood was coming from and it was running up the LAD instead of down. Very fine adaptations were discovered near the bottom, grown right round from the Circumflex.
This supply is just enough to keep the tissue alive at rest but any kind of exertion, even
standing up or eating causes an overload. The vessel has the ability to become patent,
nitrates injected into it have proved this. There is disease along the length of the LAD
but although distal, there is no concerning proximal disease. I believe if this was the
case then such a thin vessel would be blocked in several places. When the grafted
veins were open and the LAD was patent the difference I felt was undescribable. It's
just unfortunate it was so short lived. So I suppose technically, the occlusion in the
LAD is total because it's 40mm long with no possibility of blood being able to get passed
it, but through the adaptations the LAD is not closed. You have to really squint at the
angiogram to see the LAD and at first they thought it was completely closed up. With it
being so thin some cardiologists are amased I am still walking and breathing.
This is the main vessel supplying the largest area of the left ventricle and this is the most
important side of the heart. That's why they call it the widow maker.
There have been barriers throughout the last two years which have prevented this procedure, apart from finding a cardiologist with the confidence to perform it. For example, when the occlusion is removed, a very long stent will obviously have to be
fitted. Due to the occlusion being so close to the circumflex branch, it would mean the
stent covering the access to this vessel. The research college I am going to actually developed a technique which involves making a hole through the side of a stent to open
up other vessel branches. This technique was very quickly rolled out through other hospitals world wide. I'm not sure how they do this but apparently it has been very successful so far with no problems.
I have been assured I am not part of research of any kind but so far 8 cardiologists want to be present to watch this procedure be performed. Even if it was for research, I see it that if it works then it will open doors for millions of other patients if successful.
I don't know the basis of the opinion but I have heard that to reopen a totally occluded vessel is not recommended! It may be collateral vessels (if there are any) are adequate to supply blood/oxygen to the deficit area and reopening the total blockage may take away from that process?!. Also, over a period of time the normal route may have deteriorated and is no longer an adequate pathway!?
Best wishes, Ed. This is a very interesting procedure, and it sounds like you are in very good hands. Do keep us informed!
I like doctors with irreverent humor. Maybe it's because I have a warped sense of humor as well. During my last surgery the anesthesiologist came in to talk to me, ask a bazillion questions and tell me what he was going to do and the risks involved. Near the end he told me there was a chance of death. Then he leaned over and whispered, "They make me say that." I just laughed.
Im now rebooked for monday morning at 11am. I can't wait, I'm so excited now. My
new cardiologist is australian and a real character. I questioned the possibility of not
being able to get the catheter through the hardened plaque. His reply was "I'll get the
flamin thing through the blockage, dont worry about that". Then he turned on his way
out and said "but of course, that means safety first".
new cardiologist is australian and a real character. I questioned the possibility of not
being able to get the catheter through the hardened plaque. His reply was "I'll get the
flamin thing through the blockage, dont worry about that". Then he turned on his way
out and said "but of course, that means safety first".
Drat - it's hard enough to wait for a procedure but now you have to wait even longer. But I'm glad they caught the arrhythmia before they got in there. Now you're in good shape and they won't face any nasty surprises.
Sounds like a teaching hospital. During my first catheter ablation there were plenty of young cardios around to watch and be involved. Made me nervous to have so many folks looking at me. Thank goodness for the happy meds.
Sounds like a teaching hospital. During my first catheter ablation there were plenty of young cardios around to watch and be involved. Made me nervous to have so many folks looking at me. Thank goodness for the happy meds.
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