Left Diagonal Stent and LAD Compromise

[Avery618]

I read a post on this board where the DR. from Cleveland Clinic stated that stenting the Left Diagonal can compromise the LAD. My question is in what way can it compromise the LAD? The response was vague, and has piqued my curiosity. Reason is that I just had a stent put in the left diagonal due to an 80% blockage. So now I'm worried about my LAD. The cath report stated that other than the left diagonal blockage, the LAD was "unremarkable." Here is the link to the post in question: http://www.medhelp.org/posts/Heart-Disease/Chest-pain-and-Diagonal-Branch-blockage/show/254661

[Avery618]

Sorry to hear about your circumstances. Honestly, I don't feel all that much better. Maybe just a bit. I don't believe the stent has "closed off" or anything, but like you said, I'm starting to think that stenting isn't what it's always cracked up to be. Really that applies to the current methods of treating heart disease period. It's obviously not working. Look around these forums and the people that have had 6,8,10 stents, and still not better. We're missing something here. And I think it begins at the root cause of heart disease and most diseases: inflammation

[ed34]

A stent used in any proximal blockage carries a higher risk. This is because there are so many possibilities with a stent with regards to outcome. For example, you could suffer inflammation, scar tissue growth, new plaque. If these things occur, then if close enough to the LAD then the flow rate will be affected. Any tiny irregularities along an artery wall can significantly reduce flow. In Aug I went back onto the angio table because my consultant had seen a problem with my left circumflex. The registrar doing the procedure kept scratching his head at the live images because there was no problem to be seen. In the end, he passed  a flow sensor down the artery and the flow rate had reduced by 50% halfway down the vessel. The irregularities were too small to be seen but a couple of stents fixed the problem. This was explained to me by the registrar as imagining water flowing down glass, and then imagining water flowing over rocks. However, this incident has led me to lose a lot of faith in standard stenting procedures. So many times the culprit is taken to be the big blockages, but clearly this is not necessarily the case, it can be the tiniest. Perhaps this is why so many people feel just as bad after stenting.

[Avery618]

That does make sense. My blockage was in the proximal section of the diagonal, but far enough in that no part of the stent would be sticking out into the LAD. Thanks for the reply.

[Flycaster305]

I'm not a health professional, but I've had a lot of blockages and stents.  Two of my stents were in the LAD, and last spring I was diagnosed with an 80% blockage in in the First Diagonal of the LAD (along with a similiar blockage in the RCA).  Like you, I was quite symptomatic and I had a lot of angina.  However, the doctor was reluctant to insert a stent in the First Diagonal because is would compromise the LAD... both my blockages were in what is called the Ostial position, meaning at the juncture where the two vessels branched. In my case that would have meant that the stent would have had an exposed part extending into the LAD that would have been a magnet for collecting cholesterol.  In your case, your blockage must have been a further distance into the diagonal and the stent didn't stick out into the LAD.
In my case, I had  bypass surgery.
Hope that helps.