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.

[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.