Location of "ostial/proximal LAD" stent

[WRMJ]

In 2007 I had a stent put in after some mild pain walking up a steep hill.
I am now working in Japan and a recent stress test showed concern.
I requested info on where exactly stent was placed.
Received answer "3.5 X 15 mm Driver BMS Placed in Ostial/proximal LAD"
Discussion in this level of detail with Japanese doctor not completely clear.
I know "Proximal LAD" means near Left Anterior Descending Artery"
I remember from the process it was near a small branch artery.
My question:  What clue to it's location is provided by the word "ostial?
Regards,
WRMJ

[WRMJ]

Thanks.  Until you mentioned what DES stands for it had not clicked that BMS was Bare Metal

[kenkeith]

>>>>>Ostial means the opening of an artery. For a review of the architecture of the coronary arteries, the coronary artheries are normally in a groove outside the heart walls (no wall and artery noted). Sometimes there is an abnormal condition where the vessel lies beneath a layer of the heart and that is referred to as vessel bridging...not an issue. However noted, your stent implant is bare metal and not the more advanced generation of stent technology (DES) that has coating on the stent frame with an agent that helps prevent restenosis/blood clot.  I had a DES implant 7 years ago so I know the technology was available.

The Left Main coronary artery usually divides into two branches, known as the left anterior descending (LAD) and the circumflex (Cx) coronary arteries (the bifurcation is vulnerable for plaque formation). In some individuals there is a third branch arises in between the LAD and the Cx. The LAD travels in the anterior inter-ventricular groove that separates the right and the left ventricle, in the front of the heart.

The branch of interest for you is the Dx branch and  serves as the boundary between the proximal (top) and mid portion of the LAD and that portion of the artery prior to the origin of the Dx is known as the "proximal LAD", while the segment just below the Dx is the mid LAD, then distal.  The blockage you have is at the opening of the Dx of the proximal LAD. Is how I see it.

However, the description you report could be a stent in the proximal LAD near the opening (ostial) of the Dx? But I tend to believe the stent is at the opening of the Dx and the LAD remains open without a stent.

Hope the comments don't fog the issue .  Thanks for your questions and if you have any further questions or comments you are welcome to respond.  Take care.

[WRMJ]

Thank you.  Good to know.

[ed34]

A second stent CAN be put beyond an existing one. The stent is collapsed and very small upon dellivery, and is then expanded using a balloon inside the stent, which is removed once inflation/expansion has taken place.

[WRMJ]

Thank you.  Combined with what I remember this helps me locate it.
(It is in Proximal LAD near the "Diagonal 1".  In a heart diagram I found, "Diagonal 1" is labeled "Diagonal Branch of Left Anterior Descending".)
Since a I assume a second stent can not be put in through (beyond an existing stent) I wanted to know exactly where present one is.  
My big decision is if stent is needed, having it done in Japan (thru wrist) or in USA (in 2007 it was thru groin) plus the issue of ease of communication.  If it is a straightforward process then communication is not a big deal but if there are complications, I prefer in USA where I (and my wife) can easily communicate with doctors, etc..
Thanks again.

[ed34]

Nope
Proximal, mid, distal are the position along the LAD. There is a branch nearly halfway down called the Diagonal 1 and this is the marker for where the proximal LAD ends. Then at the Dx, the MID section starts. The bottom of the LAD is the Distal.

Ostial describes the direction of the disease if you like. Ostial is from the wall into the artery space, causing a restriction, usually given as a percentage. There is another word which has left my head at the moment, meaning the spread of disease down the artery wall but not ostial, just basically a thin layer covering the wall. An artery can have both types of course.