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How Common Are Angioplasty Failures?
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How Common Are Angioplasty Failures?

A couple of weeks ago, I was admitted to a hospital to have an angioplasty performed.  I have a strong family history of heart disorders - my mother, sister and brother all have had heart attacks and/or angioplasties).  I have two blocked arteries in my heart - the main one on the left near the bottom of the heart (100 percent blocked) and another a bit higher on the left (95 percent blocked).  The surgeon was unable to place stents or relieve either blockage at that time, and they sent me home with three new prescriptions for Metoprolol, Amlodipine, and Niacin.  My question is, how common is it for an angioplasty to simply be impossible to accomplish?  And can the medication changes I've received clear these blockages and eliminate the need to have an angioplasty at all (with the prerequisite lifestyle changes, which I have started to do)?
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367994_tn?1304957193
I was diagnosed with a completely blocked LAD (left descending artery) and  72% blocked circumflex.  For the past 6 years I have been on medication, exercise, proper diet, etc. and there has been no progression....and I feel fine. The totally blocked artery has other vessels that by-pass and feed into the otherwise deficit location.  The 72
%  vessel could be stented but I have no symptoms with medication so no reason to stent.

To be unable to stent an occlusion can be due to the location, too large, totally blocked and unable to work through for an opening.

The totally blocked artery at the distal end may be an area that doesn't require much oxygenated blood and other vessels may have developed to help avoid any serious damage to heart cells..
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1209084_tn?1267371006
That would be spectacular news to me if my issues could be resolved with lifestyle changes and medication as yours apparently have been. My cardiac cath was one of the most horrible experiences I have ever had, and I would do almost anything not to undergo that again (not to mention major surgery such as CABG).  Thank you for the information you have provided.
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63984_tn?1385441539
What happened during the cardiac cath that made it so difficult?  I've had quite a number of them and they have been quite routine.

I have had eight stents.  I'm one of those that can't seem to develop larger blood vessels that naturally bypass blockages, even though I keep to very tight diet, exercise every day, and take all the good drugs.  I'd certainly encourage that lifestyle, however.  There are a lot of swifter arrows in the quiver than me on this board, so take what I say with a grain of salt, but generally, blockages at the bottom of the heart generally aren't considered as dangerous as blockages higher up.  I've lived with two blockages that couldn't receive a stent at the base of the heart and was advised to take the meds, exercise, keep a heart healthy diet but expect a blockage that wouldn't be fatal, but I'd feel it.  That is exactly what happened in November, and I had a small MI, and I'm still standing.  Do you smoke?  If so, quit.  Exercise every day, and educate yourself about diet, take the drugs.  Best wishes, keep us informed.
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976897_tn?1379171202
At the end of the day, it will all depend on your symptoms. If you have a bad quality of life due to discomforts and restrictions in daily activities, then they will put more emphasis on intervention. If you have hardly any discomforts and can perform your necessary daily routines without much trouble, then they will usually put you onto a medication intervention. One doesn't work for the other. If a patient can hardly breath and suffers lots of chest pains, medication will unlikely resolve the issue.
Surgery is the option when your quality of life is too low and this usually comes in two forms, angioplasty or bypass. In your case it has been decided that stenting is not an option and so a bypass will be the option offered, should the time come. The blockage you have to keep down is the 95% near the top of the LAD. This is a very common place for blockages. As others have said, life style changes are necessary including keeping your stress levels low. Hopefully, your blockage will not increase.
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1209084_tn?1267371006
I honestly do not know if I can answer your question about what made my angioplasty so difficult, Flycaster305. To answer one of your questions, I have been virtually smoke-free since 2008 (I am down to two cigarettes a day, this from a two pack a day habit that lasted 35 years).  

The day after the procedure (presumably after I had come down from the meds), the surgeon told me that he stopped because he couldn't get the balloon through the blockages and he was afraid of tearing the arteries or knocking the blockages loose if he continued to press. He also mentioned that my intense shivering due to the cold was blurring the image on the TV monitor he was using, something that I continued to do even after I was wrapped in additional blankets.  But considering that I clearly remember watching blue koala bears with wasp-like faces climbing up and down the walls, clouds of steam issuing from the ceiling tiles, and Michelangelo-quality paintings and artwork on the entire ceiling during most of the procedure, I am not entirely sure that any recollection I could offer here could or should be trusted.  Especially considering that they took my eyeglasses away from me at the start and I am extremely nearsighted, I shouldn't have been seeing anything very clearly. But I certainly saw those creatures and steam and that magnificent artwork in clear detail. So unless they flew me to Rome and conducted my surgery in the Sistine Chapel, I would probably discount most of my recollections if I were you.

I do remember that I was told before they began that I was to be given morphine and Benadryl as an anesthetic.  I have had morphine administered to me before (car wreck back in the 80s) with no ill effects or hallucinations, so perhaps it was the Benadryl that knocked me for a loop. But I also certainly remember that whatever they gave me didn't make a dent in the intense pain I felt every time the surgeon moved that sheath and catheter.  It was like a sailor's marlinspike jabbed into my groin, and every move was like him twisting its blade.

I am pleased to hear that blockages in the lower part of the heart aren't considered as serious as others might be.  Perhaps with the passage of time and the small handful of meds I am taking, I can get by without attempting another angioplasty, something I really don't care to experience again.   I managed to walk for about 10 minutes the other day without my chest hurting too badly (only needed one nitroglycerin), so there is hope.
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1209084_tn?1267371006
Thank you for your insight and comments.  These chest pains are certainly proving to be a quality-of-life issue for me, as my job used to require me to walk up to about 5 miles a day. I would be doing extremely well today to make it 100 yards without having to stop because of the intense pain and shortness of breath. The nitroglycerin I take helps, but only enough to get home. I am going to remain optimistic that I just fell into a freakishly bad set of circumstances during my angioplasty, and that it can be accomplished successfully at another venue.
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Avatar_m_tn
This morning I walked hard  and ran upslope and feel fine.  I was running
to test again whether I would have momentary oxygen failure and had to breathe, gasping.  As usual, nothing happened.No discomfort at all.  This is the sort of thing that makes me distrust the whole situation. Just a few days ago two cardios were emphatic that I should never exercise like this   They say it is asking for a heart attack. So, at 81,  how can I run 45 minutes to a  pulse  up to 110 and feel no problem at all with breathing or balance or anything else and all this  around five times a week? The two docs were looking at the conclusions of an echocardio stress test with dobutame made LAST SEPTEMBER which 'suggested' ischemia and trifascular heart disease. The intervening five months I've been on strict lifestyle, medication and exercise. In more sober moments, I am close to accepting that I must take the advice from many on Medhelp forums and get the angio. I hope to have it done in a US funded and backed organisation.  But the surgeon who will do it will probably be the one who did the echocardiogram and concluded that there are probably three obstructions. In pessimistic moments, I wonder if he would retract his conclusion, say 'well I was wrong there' and only put in one steny if only one is  needed. There would be at least one assistant present and the results and graphs are recorded, so I should not be so suspicious.    Clearly, I have a bogey about the close network of cardiologists here (Guatemala).  I feel that none of them would question the findings of any other.  even though to me  they don't appear to agree with my symptoms. I have to deal with it, exorcise it, otherwise  I will go into the clinic in a cloud of doubt. For now I will follow Kenkeith.and if the occasional nausea, fatigu,e dizzies get too much I'll go angio. I value this column so much. Thank you all    
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367994_tn?1304957193
Oldie, if medication does not provide relief from heart related symptoms you should seriously consider intervention or non-interventional EECP.  Uncontrolled symptoms could be damaging heart cells, and that may cause irreversible heart failure.

Currently, former president Clinton had chest pains and it was diagnosed as blocked grafts from surgery in 2004, and the doctor stated there can be some expectation that the grafts may fail from 5 to 10 years although some have lasted up to 23 years. The intervention for Clinton  was to stent the old blockage! (why not stent or med the first time)?.  My heart condition is going on 6 years on medication without a problem.  The option of intervention remains if medication fails to treat symptoms. Also, there is non intervention EECP can help relieve angina (65%) by developing collateral vessels with better perfusion to deficit locations of the heart.
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Avatar_m_tn
I've had most of my symtpms since the early 80s when I was diagnosed as burned out, stressed out long before htere was any question about heart. I am trying seriously to try to separate them. For a start, four of the medications can cause nausea, dizzies and fatigue. I'll stand by and at the first scare I'll run for the angio. Meanwhile I'll research EECP which is new to me. Thank you again
Asgardshill. ?.... could you please tell us more about your medications? Did the cardio say, don't despair, fight it with these....or, maybe these will help a little...or what????
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976897_tn?1379171202
"blue koala bears with wasp-like faces climbing up and down the walls, clouds of steam issuing from the ceiling tiles, and Michelangelo-quality paintings and artwork on the entire ceiling during most of the procedure"

Whatever they gave you, I want some :)
Did you tell the cardiologist at the time that you could see those things? You know, if that happened to me, I would be thinking 24/7 wondering where the koala bear and wasp face was coming from. Do you have any idea why this combination was chosen? did you have a toy one as a child?
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Avatar_f_tn
I know some of my problems were that my veins  were very small  and the Dr.could not use a reg.stent,,he had to use the smallest stent they have, sothere are many reason,s
that stents cannot be used,  
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Avatar_m_tn
I am being pressured by three cardios to get an angio becasue a stress test five months ago  'suggested' old ischemia and triple artery trouble.  My BP is 120/80,I  bike or run/walk three to five miles  five times a week without any problem whatever with breathing, I have no pain. I get fatigue, cleared in 15 minutes lie down, dizziness nausea anxiety cleared in 25 minutes with sublingual Alprazolam (i.e. they are from old stress not heart?)
I take propafenone 150/day which unfailingly  holds my heart steady, a statin, Coreg, Vastarel, naicin 1000, fish oil 1000, aspirin and more fruit and veg than a parrott. I'm 81 , that's no time to start stenting (I hope). Please say what you are taking and what hope the cardio held out to you about medication.
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367994_tn?1304957193
I had two cardiologists.  The first cardiologist (interventional) was waiting in the emergency room when I arrived.  I was shocked to hear I had had a heart attack, and I was uninformed regarding heart issues....no family history and considered myself physically strong, etc.  I had foolishly worked in a very dusty environlment, and i contributed my dry coughing (choking) from that experience.

The ambulance-chasing cardiologist stated I had a 98% blockage of the RCA that he stented, LAD 100% blocked (nothing done) and a 72% blockage of the circumflex (not stented).  A month later the cardiologist wanted to stent the circumflex.  I challenged the doctor regarding a stent at that time and why stent now....no symptoms.  His English was barely understandable, but he muttered something.  Shortly thereafter he moved out-of-state and sent me a bill for the consultation.  He was contracted with the hospital.

The doctor I have had for the past 5 years is a non-interventionalist cardiologist.  The medication for CHF survivors are an ACE inhibitor to lower blood pressure as low as possible without symptoms.  A BETA blocker (coreg) to maintain heart regularity and ACE inhibitor properties as well.  I was on a nitrate (for angina) and a med to increase contractual strength.  My heart has returned to normal size and pumping normally.  Currently, I am on an ACE inhibitor and Coreg, statin for cholesterol and aspirin and occasionally a nitrate as needed prior to going to a workout.

A non-interventional cardiologist believes as I have stated many times.  If the symptoms can be controlled with medication, then medication...I have periodic echo, stress test, ct scan, etc.  and no progression.  In fact my exercise tolerance has increased my exercise tolerance.  And if there are symptoms, he will recommend EECP.  An interventional cardiologist is trained to do stent implants, etc. and may have a different opinion.  Do your homework on the subject, and discuss the best options with your doctor(s).
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1209084_tn?1267371006
"Whatever they gave you, I want some :)"

The hallucinations were indeed a thing of beauty.  Especially the artwork - Michelangelo's The Last Judgement, God Giving Life To Adam, Noah and the Deluge; they were all up there on that ceiling as clear as the day they were painted (a real trick considering that I didn't have my eyeglasses on and I'm extremely nearsighted).  The surgical staff didn't seem particularly concerned about all that beauty up there when I told them about it though.  Perhaps they prefer Raphael's style - everybody's a critic (shrug).

And I'm no art critic in real life, but I had just read some bits from The Agony and the Ecstasy by Irving Stone (a factional autobiography of Michelangelo) right before they took me in for the surgery. So I've got a pretty good idea about the source of at least some of my hallucinations.  I can't speak to the source of the koala bear illusions though, but suspect that the steam was condensation because the air was so bloody cold.  I've visited Australia but have no significant history with koalas, blue, insectoid, or otherwise. I have no philosophical problem with them but I certainly wouldn't invite one home to graze on my eucalyptus tree or allow one to marry my niece.

Here's the list of meds I'm currently taking - perhaps some of these will be indicative of the plan (or lack thereof) that the cardiologist has to clear my blockage or make it more manageable. (He took me off the Atenolol I was taking the day after the surgery).

Amlodipine Besylate, 5 MG 1 x day
Aspirin, 325 MG 1 x day
Hydrochlorothiazide 25 MG 1 x day
Isosorbide Mononitrate 60 MG 1 x day
Lisinopril 40 MG 1 x day
Metoprolol Tartrate, 50 MG 2 x day
Niacin, 500 MG 1 x day at bedtime
Simvastatin, 20 MG 1 x day at bedtime

I usually feel OK in the morning within an hour of taking the first load of these.  But as the day progresses, my walking range before the chest pain hits has become shorter and shorter.  Splitting up the Metoprolol into two doses was apparently meant to help with this, but it isn't working very well, which is something I'll certainly mention when I see him again later this month.
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1209084_tn?1267371006
"could you please tell us more about your medications? Did the cardio say, don't despair, fight it with these....or, maybe these will help a little...or what????"

I've posted the meds I'm taking in the reply right before this one above.  Your interpretation is essentially correct - he said to let the med changes work for a few weeks and hopefully they'll help to reduce some of the blockages. The surgeon who did the procedure said that he was afraid of tearing the blocked arteries and/or pushing the blockage downstream were he to continue prodding at them, so he stopped.
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1209084_tn?1267371006
"I'm 81 , that's no time to start stenting (I hope)."

If you've made it into your 80s, mi salud and congratulations.  I don't think any of the men in my family have lasted fourscore for at least five generations.  They all drop dead of heart attack and/or stroke well before that.
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Avatar_m_tn
Thank you for your encouragingly personal posts. They truly help me along. I had a doom for five days after the two cardios who had been telling me since october that I had no heart problem about-turned when I showed them that  FIVE-MONTH-OLD  stress test and urged: notime to waste, get an angio! I've recovered now and feel as well a s in the month before I saw them. I will read yur posts most carefully again and pull tem into my planning. Bless
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367994_tn?1304957193
Isosorbide 60 mg that is a large dose!.  Orginally, I was taking 10 mg for angina (chest pain) once daily.  Now, I only need the nitrate prior to working out.  Also, digoxin to increase contractual strength when my EF was below normal...that is no longer necessary as the heart size and EF are now normal.  I'm surprised you are not on coreg with your lisinopril...my regimen.  
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1209084_tn?1267371006
"I'm surprised you are not on coreg with your lisinopril...my regimen."

The only explanation I have is that my cardiologist figured that one beta blocker (Metoprolol) was enough.  And he discontinued the Atenolol (another beta blocker) I was taking the day after my surgery. Right after I picked up the refill from the pharmacist, of course.  So into the cat's dirty litter box they went.

The isosorbide mononitrate seemed to be effective for a couple of months in reducing (if not eliminating) the overall chest pain I was experiencing.  And it seems to continue to be effective in the morning about an hour after I first take it.  I can do light household chores now, just as long as I do them early in the day.  But it isn't touching the pain I get later in the afternoon when for example I take my walk.  That's when I need to slip in the occasional sublingual nitroglycerin to get things done later in the day.
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Avatar_m_tn
May I ask about your 'periodic' tests? Would five months between stess tests give enough time for meds to, hopefully,  make a difference that shows? Or at least show that the problem has not progressed?
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367994_tn?1304957193
At the beginning of therapy, I had an echos one year apart, subsequently, I had a stress test (treadmil) and a ct-scan 64 slice angiogram.  Blood tests have been yearly.  Visits with the doctor has been every 6 months...stethoscope, blood pressure and medication monitoring, etc.
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