How Possible to open 100% LAD Blockage

[100LAD]

I have been diagnosed with 100% blockage in LAD. Is it possible to have it opened using catheter and placing a stent.

[Christya1965]

My husband just had a procedure done where they stuck a wire in the arterie and was told the he had 100% blockage in the right one but they told him that there was nothing they could do and that a stent or bypass would not help why would he say this I know that one can be fixed i am very concerned abut this does anyone know why or what the reason is that he would say it cant be fixed

[Ger57]

Dear Christya,

when an artery is fully blocked and the cardiologist can not pry it open, it is not possible to place a stent.
Bypass is only possible when the blockage is in a position where they can place a bypass. This is not always the case.

How is your husband doing right now?
Perhaps his complaints can be managed with medication alone.

You should ask for the exact reasons why they can not fix the blockage. I assume they will provide you with the details you wish to know.

God bless,
Ger

[ed34]

That's good news but many people with such a situation aren't as fortunate. Your blockage/stents are right on the division of the main left artery (LMS). This is where it divides into the Left anterior descending and the Left Circumflex. On any branching section (bifurcation), there is lots of buffering with the pressure and turbulence, hence the reason a lot of disease starts in such areas. I'm pleased your procedure is giving good results so far and fingers crossed it continues to do so.

[Al_from_UK]

Three years ago I had two stents inserted in my LAD following the discovery of an 100% occlusion - see diagram: http://bookman2.pen.io/  

I have not had any angina symptoms since the angioplasty procedure.

[MK1952]

I have 3 stents in the every end of the LAD. 3 cardiologists have said they would have never stented.  This was in 2007 and now I am having chest pain and ischemic changes to that area. The cardiologist is saying I need to live with it and maybe it will occlude and I would have no more issues. Said it will not kill me. I am not sure I am okay with that. Should I get a Cardiac Vascular Surgeons opinion?

[ed34]

Then the collaterals are probably doing a good job. However, if they are being supplied by the right artery, this must be well maintained.If the right artery blocks, it will effectively cut off the supply to both the right and the left.

[Atulmishra10]

Thanks a lot for a quick reply ed

Doctors suggested MPS test (I assume this is called nuclear scan that you mentioned in your ans too). I think this test will give the indication about the amount of blood feed from collaterals and the total amount of blood reaching different muscle.

Just to inform you His LVEF in echo came out to be 55% which seems to be good and he is not having any chest pain or any other problem

[ed34]

kenkeith isnt here anymore.

1. A nuclear scan will establish the answer but also the angiogram will show the retrograde fill of the LAD and the vessel size. The vessel size will be a good indication of how well the blood feed from collaterals is compensating.

2. To remove a total blockage heavily calcified is very risky indeed. There is a huge chance of the catheter going through the artery wall, causing an internal bleed. If pierced, the artery can also start to break up with the blood pressure.

3. This will depend on important factors. Firstly where are the collaterals getting their feed from? probably the RCA. If this vessel is clear and maintained in the future, then yes medication alone is possible. It depends also on symptoms.

[Atulmishra10]

Hi Kenkeith,

In the angiography report of my father, doctors diagnosed 100% blockage in LAD (although this was not the cause of his recent heart attack). There was another blockage of 60% in right coronary artery and the clot got stuck there which caused the heart attack.

The LAD had total occlusion and has been calcified because of which they are not doing PTCA (angioplasty) in that and suggesting bypass surgery.

My questions :

1. This LAD seems to be blocked for more than 5 years and the collateral vessels are formed which are supplying enough blood supply to the muscles. Do you think this is good enough and can be managed with medication

2. Should we try angioplasty (stent) in this artery although doctors dont suggest that as forceful angioplasty might rupture the vessel

3. Can we go ahead with the medication only and how feasible this is.


Current Medication he is undergoing:

1. tab. Clopilet-A    [0-1-0]  (to be stopped 5 days prior to surgery)
2.tab. CAAT 40mg (Atorvastatin)    [0-0-1] (till review)
3. TAB. MEt-XL 25 mg (1-0-0)
4. TAB Hopace 2.5 mg (0-0-1)

Link to Angiogram report :

https://www.dropbox.com/sh/snalmz9wovpu3rp/vbN2wxrpYO

[ed34]

Be very careful when making your decision. You have to take many things into account and weigh up the odds. Firstly it is very obvious that collateral vessels are feeding into the LAD, else he would be in a far worse condition, probably heart failure or worse. You say that there are other blockages, apart from the LAD, and what you need to determine is which vessel is giving blood to the collaterals to feed the LAD. If that vessel becomes restricted too much, then the collaterals will give much less feed or even close. My Left circumflex has been my life line for years, and this is the vessel feeding collaterals. So far this vessel has received 3 stents and it is still wide open. Cardiologists fight to keep this vessel healthy and open so my LAD gets fed. I had a bypass in 2007, and after 3 months I suddenly dropped to my knees fighting for air. After less than 2 minutes I felt fine. An angiogram revealed that my bypass had failed to the LAD and after 2 minutes my collaterals from the left circumflex vessel re-opened making me feel much better. You are right to wonder why surgery would be recommended if there are no symptoms, but you need to establish where the LAD is currently getting its feed from.

[Occupant]

You are a little late in agreeing with Kenkeith's comments. He hasn't been on this forum for a long time. However, my thoughts on this are: if your dad's LAD is blocked 100% he has to have developed collaterals. If you bypass the LAD chances are the collaterals will close and if the bypass subsequently closes up on him again, they might not open up again - end of the line. Did your dad have a Nuclear Stress test to determine if the blood supply to the heart is ok otherwise and no damage to heart tissue has occurred?

[DhirajS]

hi Kenkeith

I agree with your  comments

My question before you is the following

My dad has 100% blocked LAD. He has blockages in other 8 areas as well. He is stable and doesn't have any chest pain as such.

He suffered an attack 3 years ago and since then he was on medication. it is only 6 months back that he went for an angiography. It was just routine. He didn't have any chest pain or other problems when he decided to go for an angioplasty.

The angioplasty showed blockages at 6 to 7 years with LAD blocked 100%. The doctor advised us to go for an bypass immediately.

Now if he is not facing any problem then why does he need to go for an bypass?

He can walk for 40 minutes. now we are in a dilemma whether to go for an bypass or not?

Pls mark a copy of yoru reply to my email id ***@****

Thanks
Dhiraj

[paperpest]

Thumbs up for all the good information you have given 100LAD.  I'm someone with a 100% blocked LAD.  I am on a medical regimen.  Drs. Samin Sharma and A. Kini at Mt. Sinai in NYC were unable to open my totally occluded artery.

[sandviper]

try this    http://www.trackyourplaque.com/

[ed34]

Chelation hasn't been proved to work. If you imagine chelation removing calcium from the arteries, then this would make a diseased vessel much more risky for causing deadly blockages. Calcified plaque is often in the form of a 'cap', holding back the soft plaque inside the artery wall. The whole idea is to hope this cap doesn't break. If chelation makes the caps weak, lots of soft plaque will leak into the artery, causing a clot further down the vessel. The artery lining will then signal passing platelets to stick to the damaged area, where the cap was, and form a second clot. Very rarely do people survive from a double whammy.

[joey332]

I don`t see any comment about chelation therapy. Why?

[100LAD]

I too was looking for the "right answr". I was getting increasingly confused. Doctors giving me different opinion s. I had my surgery on 25/6/2010. A year & a half later, I feel that one can never the find the right answer.

[Occupant]

Of course, you can keep on looking, but I doubt that you will find an answer. I had a Calcium Score of 1242 with the LAD at 782, no Angiogram and no Angina. But, there has to be considerable blockage just how much I don't know. The cardiologist said, you'll live another 30 years which would really be an accomplishment as I am already 75, so I dismissed it and stopped looking for answers.

[jspec]

Reading what is here has showed me that there is no right answer. Each case will be different, each doctor will have his own opinions. Im 53, I had a heart attack on thanksgiving day, went to the emergency room and was told my lad was 100% blocked. Half an hour later a full metal stent was put in and the pain went away immediately. Its now going on Jan. 1, so far so good. I have type 2 diabetes that im controlling with diet and meds, plavix and asprin for the blood, 30 min. of walking a day, had my last cigarette on thanksgiving day. I wake up every day wondering if it will be my last. I came here trying to find out if my time is limited or if I keep doing what Im doing will I live to a ripe old age, I guess I will have to keep looking.

[ed34]

what are your symptoms?

[alok949]

My recent report says , Occlusion of Proximal segment of LAD with poor opacification of mid &distal LAD....,while my 2d echo report says - Ejection Fraction is 60 percent...What do I make of it?
And my CT angiography says - Significant stenosis (>70%) of distal RCA & mild stenosis of mid RCA. That was the impression from my CT . Would someone analyse this for me. Should I ignore the LAD and go for a stent in RCA . The rest of the report is normal except for some calcification which is quite high. 208.5 (Normal being up to 100)

[kenkeith]

Yes, I think we should end it here because I don't think you've grasped anything I''ve tried to say.
Amen"
You can stop the argumentative dialog because you are not offering  any insight. You have an extensive record for arguing and insulting, and it is disruptive.  I understand, so please...

[ed34]

A Cardiologist will give his opinion on what benefits you should receive when a procedure is performed, but this doesn't mean this will be the outcome. To be honest I think there is much still to be learned about the problems with angina. I was told by lots of cardiologists over a two year period that my blocked LAD was the big problem, if that was treated then I would be running around again. Well the blockage has been removed and to be honest with you, there's not much difference at all. I witnessed the huge increase of blood flow into my LAD when he broke through the blockage, I even witnessed my ECG suddenly change. Everyone was excited, thinking I would now have no physical restrictions. How wrong everyone was. So, before you have any procedure, don't assume it will be a magical solution to your symptoms because that isn't reality. Some people obviously feel great after a blockage is treated, but many do not.
Now cardiologists are stumped because they can see no reason for my angina on any scans and my EF is 70%.

[ed34]

"We can agree to disagree on the meaning of cure"

Yes, I think we should end it here because I don't think you've grasped anything I''ve tried to say.
Amen

[kenkeith]

I can understand your concern with serious choices that involve your health.  I suggest you post your question of concern with the cardiac experts' forum.  If you page down and to right you will see the appropriate link.  Unfortunately there doesn't seem to be any response to followup questions so may want to draft your question with that in mind.  Good luck and take care.