Medical Management vs. Stenting

Looking for advice from an expert.  Husband has 50% blockage in Proximal LAD, 60% in Mid RCA, 50% in 1st marginal, 70% in 1st Diagonal and a 100% blocked distal circumflex which could not be stented due to calficication.  Suspected infarction in the 100% blocked artery.   Husband went to the hospital when he felt symptoms of extreme exhaustion.  It was determined he had heart attack due to blood test results.  Ejection fraction is 60%.  Echocardiogram was essentially normal upon release from hospital.  Doctor who performed catherization and could not stent 100% blocked artery  feels husband will do fine on medication alone.  Husband went for a 2nd opinion and was told he should have the 100%, 70% and 60% blocked arteries stented.  We would both prefer medical management.  

Husband is in shape, exercises each day, eats well.  He has no angina or other symptoms of heart  problems.  He is on Plavix, Lipitor, Lisinopril, and Metroprolol and an adult aspirin.  His cholesterol is high and he hopes that the Lipitor will help to lower it.

Any thoughts on which direction my husband should take -- medical management or stents?
Thank you in advance.

[ChatterAlly]

I am currently on medicinal management, but would go ahead with intervention if symptoms get any worse. I do have 2 stents in my RCA, but the blockage being watched now will require bypass. I can't see going through all of that for single vessel.  If it were me, in your husband's case, if they are able to stent those blockages, I would go for that. There is really no down time with stents. But, that is just my opinion. Take care and keep us posted.  Ally

[nagrajjain]

Once you go for stent you may have to go for stent again and again and afterwords for bypass again and again. That is what I see from the experience of many peoples. To save in emmergencies stent or bypass is ok. But without any symptoms to go for may not be advisable. You can go through my case and contact me if you feel so.

[ed34]

That's because the disease is not brought under control. Yes with bypass you may have to have further surgery, with stenting you may have to have further stents, but this isn't the fault of the procedures, it's because so many people don't make the necessary lifestyle changes required. Without the intervention, the disease would continue to form blockages. The whole idea is to get the blockages intervened, then make lots of strict changes in your life to stop the progression of the disease. A stent doesn't cause further stenting requirements. What will cause this is if people carry on smoking, carry on eating high fat diets, continue not to exercise and continue to suffer lots of stress in their lives. We can't go on blaming intervention saying it doesn't work, because for millions it does, it works for those willing to work at it.
I've seen such patients when I've been in hospital. They have stents and sneak outside the hospital several times a day for a cigarette. Some even had their family sneak in McDonalds every day. These are the people who make intervention a waste of time and make it look bad. They truly believe that a statin a day will keep that fat away.

[kenkeith]

One can "work at without" a stent or any intervention.  Stents can be harmful when the interventionalist does not consider reperfusion damage, interference with collateral vessel flow, etc.  There can be restenosis, damage to endothelium cells, scar tissue rather than endothelium cell replacement, stent collapse, rupture during process, infection, vessel thrombosis, etc.  And has anyone considered there may be a connection with the placement of a stent and increased blood flow there can reduced blood flow to another site,  and that would then require another stent within relatively short time.

To stop or slow progress of CAD is not implanting stent, but as Ed states there needs to be some self help with proper diet, exercise, etc.  Oh, a stent works in the short term and it opens a vessel for better blood flow, but with medication vessels can relax and widen the diameter of the vessel as well.for better flow.  What is the advantage of mechanically opening the vessel? I would rather leave my option remain for a stent later if necessary.

[mark_m60447]

Last September I had a stent placed inside a drug eluting stent that had been placed 8 yrs earlier.  There was no significant increase in plaque build up because I started taking Co Q10 and fish oil and product called Cardio Clear (Calcium based Oral Chelation) but it had become 100% blocked with scar tissue and a clot. (collateral arteries prevented anything
more serious than angina)   The team at Mayo Clinic in Rochester, MN was able to poke through the scar tissue and open it up to 80% so they could place another stent inside but what happens when that one has the same problem in another 8 yrs?  I can't keep putting stents inside of stents forever.  This seems too much like a way to insure repeat business and basically signs a long term death warrant for the patient.    I really DON'T want an endarterectomy or bypass.
I've read they've developed a way to remove a stent in Switzerland but I was not able to find out enough information to know if it only worked for recently placed stents. What about the roto rooter option? I would think it would be able also clean out the scar tissue without injuring the artery wall..  

[ed34]

A roto-rooter requires a guide wire as central as possible through the artery. It basically slides along this as a guide. It has diamond tips on the front and is olive shaped, but it doesn't leave an artery smooth enough for concerns about re-stenosis to be dropped. Far from it, the artery lining will be very rough and encourage clots and anticoagulation medication may prevent this, but the other problem still remaining is scar tissue growth. Behind any disease which is in the artery Lumen, the endothelium cells will be damaged and encourage both clotting and scar tissue to grow.
This brings me to chelation. If you imagine a host of cells inside the artery lining, composed not just of fats, but of red/white cells etc, this is a nasty sticky substance which you don't want floating around in your blood because it could very easily cause a stroke. What holds this sticky stuff in the artery wall? calcified plaque. It acts as a protective cover and when this cover fractures, it's heart attack time. Why would you want to take chelation chemicals to remove the only safety factor you have? if the chelation breaks down the calcium cover, then you will have lots of the sticky nasty stuff floating around just waiting for a place to lodge and block the vessel.