PTCA Ostium Distal Circumflex

I recently had multiple PTCA with stents.  The last angiogram revealed an increase in occlusion from 30 to 70 percent over a three week perios (periods) of the distal portion of circumflex ostium.  PTCA was not performed due to the complexity of the procedure.

Is it reasonable to pursue revascularization with angina on exeration and rest.  All standard meds are in place, with low LDL, plavix, bet-blockers,etc.

[CCF-M.D.-MJM]

Hello,

Sorry to hear you still have angina despite therapy.  Certainly angina that impares your quality of life, especially at rest, is an indication for intervention.  The question is can it be done?   What region is causing the ischemia?

Before intervening on a single lesion, especially if it is a small vessel, it is worth investigating where the ischemia is.  A thalium stress test or a PET scan may reveal the area of ischemia.  If the region of ischemia matches the territory seen on the tests, that is a stronger case to take on a potentially more difficult intervention.

If you doctor does not want to do it, get a second opinion a referral hospital. We receive a lot of consults for difficult intervention that other practice do not want to do and have doctors that specialize in these cases (Dr. Whitlow and Dr. Franco).

I hope this answers your question.  Thanks for posting.

[gsilvers]

Thanks for the comments.  I've recently had the Nuc stress test & echo but no PET scan.  All th estudies are burned on CDs and I've made an appointment to see Dr. Ellis next month.

[MaryRoe]

Hi there.  I also have similar.  I have an area in the distal LAD that doctors here in Houston say cannot stent or by-pass as it is too small a vessel.  I have the CD's of the Heart Cath's but did not know you can get a Nuclear study on a CD or an echocardiogram on a CD.  (have had 9 Echos' in the past 8 months)   Was your study a Nuclear Cardiolite?  This does show the distal problem in me but I am thinking of a stress thallium or a pet scan also as these are done in hopsital settings and not in a doctor's office like a Cardiolite is done.  I think these two tests are more senstive to issues.  Good Luck to you.

[Wendel]

I had an angioplasty procedure 3 weeks ago to clear 3 blockages (2 @ 90% and 1 @ 95%). Stents were inserted in two. I had some intermal bleeding after the procedure in the groin area. This area is still quite sore with a good size lump present. I am taking Plavix, altace, metroprolol and aspirin. Almost regularly I feel a chest discomfort which extends to the throat area, similar to indigestion. I have also recently had a couple of incidents where there was a tight feeling in my chest and my hands were sweating. I was not exerting myself at either time. If this had happened prior to the procedure I would have attributed them to angina. However the procedure should have alleviated this? I've read that the medication can cause side effects such as chest pains and throat constriction. Should I be concerned?  Thanks. Wendel