To Stent or NOT to Stent.....??? Please help.

[isabel174]

I have a 100% blockage for my LCA and I've had a DES Stent placed in my RCA that had a 95% blockage. My Ejection Fracture rate is 50%. Is it worth it to have a DES Stent placed in my LCA to clear the blockage. My heart also built collateral arteries for the LCA.

[nagrajjain]

If you are on medicines and you do not have pain then probably you can manage with medicines only. Chest pain, heart attack and finally heart fail are all posibilities as the time passes. Control chlorstrole by exercise and food and medicines. Periodic checking must for l.v.ejection fraction too.

[ed34]

I think a lot of it depends on the experience of the cardiologist. I had a cardiologist with 30+ years experience in PCI, but he still very nearly dissected my LAD. He pierced the lining, but thank goodness it didn't go all the way through. Risk factors involve a few things. First, the occlusion may be too hard to get a catheter through it to the other side. Lasers, cutters, rotoblators etc slide along the catheter as a guide, so it has to be right through the blockage and central. If the occlusion is too hard, then bypass is the only solution. When a blockage is in a curved section of artery, this makes it even more difficult to estimate if the catheter is central through the blockage. If it isnt, you have the danger of drilling through the artery wall.
I had 5 of the longest stents put into my LAD and it took several hours.

[jrbon]

Isabel and Ed,

I do not know how difficult is to open a LAD, what I can tell you is that, after I arrived in an emergency state (HA), at 4 in the morning, to the cath. room I got a report that says: "LAD with complete occlusion proximal"

But the report also indicate that they injected abeiximab to solve the thrombus and in 2 different sessions they put 4 stents in the LAD to open it (with a total length of 7 cm).

They had to do it in 2 sessions because during the first one I when into cardiogenic  shock and they have to stop it after inserting a counter pulse balloon connected to a computer.

Perhaps they did not mind to do it because anyway I was dying. I know for sure that they saved my life.

Jesus

[ChatterAlly]

How is your overall health with the blockage? I mean do you feel impaired with the blockage?  I would go for the stent if that was the option and I wasn't feeling well without it. But that's just me.  If you have an EF of 50% and you have built collaterals and don't feel slowed down at all, then like Flycaster said, with the right meds, heart healthy diet and exercise routine you should be fine without any intervention.  Take care, Ally

[ed34]

Collaterals are not always the solution. In my case, I had a totally blocked LAD at the top, but collaterals fed through the bottom of the vessel. Great that it kept me alive, but it certainly wasn't enough for exertion. Meds helped with pain control, but not with exertion, in fact when on beta blockers I had less energy to do much. Some people develop a good collateral feed, while some have a small feed, and others don't develop any. It is risky to remove a total blockage in the LAD and I'm surprised this is an option. I had to have a triple bypass, but as this failed after 3 months, it was my only alternative apart from accept I was partially disabled. I think age has a lot to do with it, I was 47 when I suffered an MI and have been very active all my life. I wasn't ready to concede to defeat.

[Flycaster305]

I'm not a health professional, but if the Left Artery is 100% blocked it is next to impossible to accept a stent.  If your heart has developed collateral arteries, and your EF is 50%, it sounds to me that you should continue with good meds, exercise, control your diet.  Kenkeith who monitors this board has experienced this condition, and hopefully will respond.