angioplasy

[nancy__0__0]

  my father is 59 years old.  4 years ago he had a quaduple bypass.  for the past 3 years he has had 7 angioplasy's with stents(Spelling?).  every 3 to 5 months he's gone back in with another major artery clogged and had an angiogram followed by plasty.  In april he had his first heart attack, minor followed with stent and plasty.  Thursday he had a massive heart attack in the right bottom portion of heart.  Today they performed angiosplasty, the artery they fixed in april was 90% clogged.  another artery is completely clogged and remains clogged.  In the past his cholesterol was high about 300.  They gave him lipitore(?) and it has been down to 110 for the past 3 weeks.  He has always eaten right, he excersises daily, walks 3 miles a day and is thin.  I'm not sure how many more trips to the cath lab he can take.  Is there something we're missing, is there a more effective proceedure.  With this last heart attack his heart was damaged (the first one didn't).  What could be causing the arteries to clogg so quickly and completely?????  I would appreciate any information you can give us, we're pretty worn out.

[CCF CARDIO MD APS]

Dear Nancy,
For patients like your father who have aggressive plaque(blockage) formation in
the arteries following surgery and or angioplasty with or without stenting, there are
often no answers and very few treatment options.  The main goal of course is to
preserve the cardiac function or at least minimize the size and or number of heart attacks.
Those patients with diabetes and high cholesterol levels do seem to be at more
risk to have this aggressive plaque re-formation in the coronaries and in the
grafts, however we have shown that being on anti-cholesterol medications like
lipitor does decrease the incidence of recurrent events (of course, it is not
100%, i.e. not all paitents see the benefit of the drug and at the present time
physicians and scientists are attempting to figure out why some patients respond
while others do not.)  
Sometimes the cause of multiple trips to the catheterization lab is found, and
often it is that the person has a blood test abnormality (either too much of a clotting factor,
or too many antibodies to the blood thinners we use in the cath lab, etc.)
Unfortuntely, in most patients, especially diabetics, the cause of the increased
plaque formation is not understood and at this point not treatable except with multiple trips to
the cath lab and surgery suite, as well as aggressive medical management of their disease.  
It must be very difficult for your father to withstand so many trips, however so long as he has
significant angina and or an abnormal stress test, the best move is to go in an re-open the artery-
if only to prevent further damage.  The reason why we are so geared toward maintaining the function of
the left ventricle/pump (i.e.minimizing the damage) is because the worse your pump, the higher the risk of
death for that patient each year that s/he lives.
Asking your fathers' physicians if they have tested for the unlikely causes of aggressive clot formation as
I spoke of above (these states are rare but should be ruled out in patients like your dad)
is one thing you can do, otherwise keep up your tremendous support.
I hope you find this information useful.  Information provided in the heart forum is for general medical informational purposes only.  Only your physician can provide specific diagnosis and therapies.  
Please feel free to write back with additional questions.
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 problem.