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Heart Disease (Expert Forum)
Re: Atherectomy/PCTA---Benefit Gained?
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Re: Atherectomy/PCTA---Benefit Gained?
by CCF CARDIO MD DLB, Jan 01, 1995 12:00AM
Posted By CCF CARDIO MD - DLB on February 14, 1999 at 14:51:55:
In Reply to: Atherectomy/PCTA---Benefit Gained? posted by Rich on February 14, 1999 at 14:18:27:
My cardiologist has recommended an angioplasty, with atherectomy. I hestitate for two reasons: benefit to be gained (vs. risk), and the procedure itself. I have no real symptoms except occasional angina-like feelings due to stress, not exercise. My doctors are not even sure if this is cardiac-related, although other tests have eliminated most non-cardiac causes.
I have recently had my second angiogram, which shows an approximate 80% blockage (mostly calcified, some softer) in the LAD artery; this is a small increase from an angiogram 5 years ago. The LCX is fine, but, for at least 5 years, the RCA has had a complete blockage mid-way. A good collatoral network has established itself to offset the RCA loss.
Stress-thalium tests (13 METS) indicate EKG changes and mild inferoseptal hypoperfusion only at higher levels of exercise. Echo results are good, with EF over 60%. I am 50 years old, blood pressure, weight, cholesterol, and other risk factors under control and management. Family history is not favorable, both parents have died due to heart problems. I am on moderate dosages of betapace, norvasc, lipitor, and aspirin.
These are the basic facts. As to benefit vs. risk, the cardiologist who would be pefroming the procedure states that there is a good chance that there would be no improvement in my angina-like symptoms, which don't affect my quality of life that much anyway. So, I'm not sure what is to be gained from this procedure. My readings tell me that the longer term risk of death/MI is not reduced by this procedure compared to medication treatment. I do know, however, the risks involved. I'm afraid I might be starting down a slippery slope at a fairly young (relatively!) age. Any insights on other benefits to be gained (vs. risks) would be very much appreciated.
Concerning the procedure itself, my doctor proposes a Rotablator procedure, pcta, maybe a stent (determined during procedure). He does not want to use any of the newer antiplatelet therapies which appear to offer universal benefits during this procedure. I am far from qualified to comment on this strategy, but am somewhat confused by the reluctance to use newer, proven technolgy. Any comments on this proposed procedure are also appreciated. I also question if I should delay until promising newer procedures such as radiation tcpa are approved for use.
Thanks again for your help.
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Dear Rich
This is a difficult question, as you have framed it. I find it hard to believe that the stress test does not show more ischemia, if the LAD blockage really is that severe. Nevertheless, if you were my patient, I would probably open up the blockage in the LAD. It would probably not make you feel better, since you claim that you feel well (though you have had more cardiac tests than I would expect if you really are feeling well). I cannot say that the procedure will make you live longer; and the procedure itself has real risks of heart attack and death associated with it. However, if that 80 percent blockage were to close up, it would almost certainly result in a fatal event. Thus, most cardiologists would probably recommend opening it up.
Regarding antiplatelet therapies, having pioneered their use during angioplasty, we are big fans of them here at the Cleveland Clinic. However, it is up to your own cardiologist, not you or me, to weigh the risks (such as bleeding) and benefits of these agents in your particular case. As far as waiting for new technologies, radiation does appear to be promising, but it will be a while before it is available outside of clinical trials. The danger of waiting for any improvements is that something bad could happen to you while you are waiting.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
In Reply to: Atherectomy/PCTA---Benefit Gained? posted by Rich on February 14, 1999 at 14:18:27:
My cardiologist has recommended an angioplasty, with atherectomy. I hestitate for two reasons: benefit to be gained (vs. risk), and the procedure itself. I have no real symptoms except occasional angina-like feelings due to stress, not exercise. My doctors are not even sure if this is cardiac-related, although other tests have eliminated most non-cardiac causes.
I have recently had my second angiogram, which shows an approximate 80% blockage (mostly calcified, some softer) in the LAD artery; this is a small increase from an angiogram 5 years ago. The LCX is fine, but, for at least 5 years, the RCA has had a complete blockage mid-way. A good collatoral network has established itself to offset the RCA loss.
Stress-thalium tests (13 METS) indicate EKG changes and mild inferoseptal hypoperfusion only at higher levels of exercise. Echo results are good, with EF over 60%. I am 50 years old, blood pressure, weight, cholesterol, and other risk factors under control and management. Family history is not favorable, both parents have died due to heart problems. I am on moderate dosages of betapace, norvasc, lipitor, and aspirin.
These are the basic facts. As to benefit vs. risk, the cardiologist who would be pefroming the procedure states that there is a good chance that there would be no improvement in my angina-like symptoms, which don't affect my quality of life that much anyway. So, I'm not sure what is to be gained from this procedure. My readings tell me that the longer term risk of death/MI is not reduced by this procedure compared to medication treatment. I do know, however, the risks involved. I'm afraid I might be starting down a slippery slope at a fairly young (relatively!) age. Any insights on other benefits to be gained (vs. risks) would be very much appreciated.
Concerning the procedure itself, my doctor proposes a Rotablator procedure, pcta, maybe a stent (determined during procedure). He does not want to use any of the newer antiplatelet therapies which appear to offer universal benefits during this procedure. I am far from qualified to comment on this strategy, but am somewhat confused by the reluctance to use newer, proven technolgy. Any comments on this proposed procedure are also appreciated. I also question if I should delay until promising newer procedures such as radiation tcpa are approved for use.
Thanks again for your help.
------------------------------------------------------------------------------------
Dear Rich
This is a difficult question, as you have framed it. I find it hard to believe that the stress test does not show more ischemia, if the LAD blockage really is that severe. Nevertheless, if you were my patient, I would probably open up the blockage in the LAD. It would probably not make you feel better, since you claim that you feel well (though you have had more cardiac tests than I would expect if you really are feeling well). I cannot say that the procedure will make you live longer; and the procedure itself has real risks of heart attack and death associated with it. However, if that 80 percent blockage were to close up, it would almost certainly result in a fatal event. Thus, most cardiologists would probably recommend opening it up.
Regarding antiplatelet therapies, having pioneered their use during angioplasty, we are big fans of them here at the Cleveland Clinic. However, it is up to your own cardiologist, not you or me, to weigh the risks (such as bleeding) and benefits of these agents in your particular case. As far as waiting for new technologies, radiation does appear to be promising, but it will be a while before it is available outside of clinical trials. The danger of waiting for any improvements is that something bad could happen to you while you are waiting.
I hope this has been useful. I wish you the best of luck. Feel free to write back.
Information provided here is for general purposes only. Specific questions should be addressed to your own doctor. If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
