Is Stenting or Bypass Surgery better in the long term?
It was discovered in 2005 that I had CAD with four blockages-95%LAD, another 80% LAD in smaller vessel, and two 60% Circumflex blockages. The 95% LAD was stented with a drug eluding stent. In November 2008 I suffered a heart attack and was hospitalized and recatherized. This time one of my Circumflex blockages had increased to 95% and another 95% blockage was found in the Coronary artery to which both were stented with bare metal stents. I also had another major blockage but it was left unstented due to the reqirement of a drug eluding stent and the fact I was scheduled for neck surgery three days after the heart attack and was postponed for obvious reasons. My cardiologist insist stenting is the right way to go. While hospitalized with the heart attack my catherization site began bleeding more than anticipated and the nurse summoned a doctor- who happened to be from the bypass surgery team. While taking care of the bleeding problem, this doctor asked me why I was fooling around with stents and not getting the problem repaired correctly? I was a bit dumb founded as I had discussed this issue before with my regular cardiologist- who by the way has a very good reputation and is with a large group of cardiologist. When I went back for my check up after the hospitalization, I consulted my cardiologist again why they did not do bypass due to the numerous blockages I have. His reply this time was: It depends on whether you ask that question to your cardiologist or a cardiac surgeon". What kind of an answer is that? Are we talking my health and life here or how much money can be made off my misfortune???
MY QUESTION: Is bypass surgery better than stenting, especially under my circumstances? Also, once a bypass has been performed, can that same vessel be bypassed again if it should ever occlude again? My cardiologist told me bypass is a one shot deal however, my uncle has already had three bypass surgeries- I don't know if any were on the same vessel again.
The guidelines for treatment of CAD. If occlusion is less than 70%, no intervention. If lesions are greater than 70% treat with medication for angina (chest pain, etc.). If medication does not control angina, then stent.
Bypass is appropriate if stents cannot be properly implanted due to location, excessive number of lesions, then a bypass. Also, a bypass may be done in the event of an emergency.
There are limits to the number of bypass as there is a finite number of veins that can be harvested. The harvested vessel is vulnerable as any other vessel to occlude, etc. It can be stented, etc.
Doctors are biased to their speciality. An interventional cardiologist favors doing a cath angiogram and stent. A non-interventional cardiologist is not as quick to do any interventional treatment, and favors medication. My first cardiologist liked to do cath angiograms (wanted to do stent a 72% blockage of the ICX after stented the RCA two months prior...I had no symptoms. My current cardiologist treats with medication for the past 5 years and I have no medical problems associated with CAD..
All of our family which includes approximately 75 people on my mom's side has heart disease. My mom battled heart disease, CHF, cardiomyopathy, plugged arteries, and valve disease for over 12 years. Each time she had surgery, we moved into the hospital for weeks. The first time 3 weeks and the second time 1 1/2 weeks for me and 3 weeks for my dad. We slept in the waiting room with other people awaiting their loved ones recovering. We spoke with many of these people and many many heart surgeons. What the heart surgeons told us was that the bypass was a fixed and the stents were like a band-aid buying more time. A lot of the time the arteries plug up because they have twists and turns and as the blood rushes through there because a sticky spot in the artery were cholesterol plaque sticks. When new bypasses are put in they are more straight therefore fixing the problem. Stents only hold the artery open and a lot of the time cholesterol builds up within the stents and then a bypasses has to be done to fix that. Open heart surgery has risk and 1 in 5 do not survive in otherwise healthy people. Heart surgeons have told me that in the future there will be no more open heart surgeries performed. It will all be done through a catheter or another noninvasive type of surgery. The questions then is will the stents buy you enough time as to then be able to have cath surgery or should you have open heart surgery to fix the problem. A person can only have so many open heart surgeries because of the scar tissue from having one. My mom could only have two and my cousin could only have three. You are still young so you may want to consider the bypass surgery or talk to some top heart surgeons. Make sure that you are at the best hospital in your area and that the surgeons do many. Make sure that you are on some good heart medication to help prevent further blockage and be strict with your diet. The small vessels in a heart can also plug up and if too many plug up and if there are heart attacks in them, it can cause cardiomyopathy which is disease of the heart muscle and the heart can hardened. There is a lot to think about and different doctors may have a different opinion. Take your time with making your decision. Are you taking Plavix for your stents? Plavix helps to prevent blood clot which with drug stents there is a higher chance of blood clots and heart attacks. Hope you are feeling better.
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