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Stents vs. Medical Management

My husband had a heart attack one month ago.  His distal circumflex is 100% blocked.  Attempted to stent it and it was too calcified to stent. He has very good collaterals in this area.  Proximal LAD is blocked 50%.  Mid RCA is blocked 60%.  1st marginal is blocked 50%.  1st diagonal is blocked 70%.  Interventional cardiologist said he will do fine with medical management.  He said that stents do not prevent heart attacks and can cause their own problems.  He has no angina.
We followed up with another cardiologist who recommended that the 100% blocked distal circumflex be stented as well as the 60% blocked and 70% blocked arteries.  This is the treatment he recommends to preseve my husband's quality of life down the road.  He unblocks 100% arteries 100 times a year.  His echo is normal after heart attack and his ejection fraction is 60%.  The interventional cardiologist who performed the procedure said he basically has no heart damage.

Husband feels good right now.  He is on Plavix, daily aspirin, Toprol and Lisinopril.

Should we go the medical management route or go with the stenting?  Thank you for your time.
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367994 tn?1304953593
No problem!  Happens frequently, I usually catch and have it deleted!
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Avatar universal
Thanks for the response. Sorry for the double post.
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367994 tn?1304953593
There should be no problem going with the medication therapy.  I have going on 7 years with medication (100% blocked LAD and 72% blocked circumflex). I had had a heart attack, but no permanent heart cell damage.   Stent or medication widens the diameter of the coronary arteries.  If medication provides an adequate supply of blood and collaterals have vasculated possitively, there may be no need for a stent implant.  

The 60 and 70% lesions have been recognized by the AHA/AAC guidelines to not stent or bypass unless medication cannot manage and control angina pectoris (chest pain). Of course there are exceptions.

If the quality of life is effected later in life as the doctor states, the stents can be done at that time.  Also, who knows what the state-of-art treatment will be later! Could there ever be a drug infusion at the site of the blackage to dissolve the blockage?  It has been said by some doctors that cholesterol medication that raising the HDL can reverse plaque buildup?!

If you have an interventional cardiologist that states medical therapy is sufficient (it is true it does not prevent heart attacks and does have its own problems), I would go with that decision...why go with some procedure that speculates a better quality of life later? The option for a stent remains going forward without any risk if medication is no longer effective.

Thanks for sharing, and if you have any followup questions you are welcome to respond.  


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