HEART DISEASE COMMUNITY
RE-CABG or 6 stents recommended, any advice?

RE-CABG or 6 stents recommended, any advice?

I apologize in advance if I have included too much info with this post. If there are no replies I will understand.  We have refused recommendations and are now following Ornish/Esselstyn dietary guidelines for reversing CAD, hoping for collaterals and planning to contact Cleveland Clinic regarding laser or cutter cath intervention.  My (61 years young) husband had emergency CABG 1/2010, x4, was doing great with recovery and rehab until 5/10 when angina returned.  EF was 60% prior to surgery, now 50%.  We feel CABG had value due to LAD being 80% blocked prior.  He is still working full time but very tired in am and pm.  He has no left over energy on the days he works and our quality of life is diminished.  Maybe vegan diet is to blame?  
Excerpt  from Angiogram report below (5/18/2010) identified only one saphenous vein graft.
1.The left main has mild disease.  
2.The circumflex has 60% stenosis to the midvessel.  The marginal branch is grafted via saphenous vein graft.  The saphenous vein graft to the marginal has a proximal 85% stenosis, and then there is a 95% stenosis on the marginal of the ramus has a 99% stenosis presumably where the graft was previously anastomosed.
3.  this portion appears to be missing from report, maybe a transcription error?
4.  LAD has severe proximal disease and is grafted distally via widely patent LIMA.  Distal flow is excellent, and there are no lesions beyond the graft insertion.  The first diagonal branch has a long disease segment from the proximal to the midvessel of 80%.
5.  The right coronary artery has a mid 90% stenosis.  The PDA has a 99% midstenosis.
     SVG to RCA - occluded, SVG to ramus occluded, SVG to marginal branch has a proximal 85% stenosis and then a 90% stenosis at the distal anastomosis.
Report goes on to say he had severe diseased vessels which were small caliber, thus the occlusion of the 2 SVG may be from the severe diffuse disease.  (Why would re-CABG be a good option if the vessels are small caliber ?

His cardiologist's recommendation:  The graft to the marginal branch can be treated with a stent at it's origin and possibly a stent at the anastomosis if after angioplasty the distal vessel appears large enough.  Would also attempt angioplasty and stenting of the mid RCA and at least angioplasty of the PDA.  The ramus branch also should be revascularized at the same setting.  The diagonal branch has a long diffuse disease segment, which I would manage medically.    
Frankly, we are not comfortable with of all of these long stents that might preclude re-CABG (full metal jacket) if necessary to save his life.  This is scary territory to be in and we feel like we are on our own,  non compliant mavericks... Cardiologist said he is a complex case and may want to go to a teaching hospital for another opinion.  Meanwhile we eat sticks and twigs together while waiting for residents to get settled before seeking treatment in September.

Tags: cabg, stents
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