scar tissue in coronary need info on SCRIPPS

  I have had a triple bypass on Dec. 1995, PTCA August 6, 1996 finding occlusion from scar tissue closing the grafts then August 21, 1997 PTCA for a stent attempt and angioplasty (unsuccessfull), Sept. 24, 1997 rotorblader, angioplasty with 2 stents j&j in the right coronary near ostium, June 17, 1998 angioplasty and large stent closer to ostium as previous stents left right coronary unprotected. July 31, 1998 repeat PTCA showed blockage already 50% due to thick scar tissue. Since bypass have had angina & back pain. Currently on Atenolol 50mg. twice daily, Norvasc 10mg. daily, Imdur 60mg. am & 30mg. pm, Ecotrin 325mg. daily, Premphase 0.625 daily, Zanax .5mg four times a day, Zocor 40mg. one pm. Relafin as needed 500mg. Zantac 150mg. twice daily as needed, nitro patch 0.4mg. twelve hours daily, nitrostat as needed under tongue, vitamin e 400mg. Options given to me on the 31st of July were if blockage progresses possible repeat bypass or radiation therapy for right coronary. Left mammory is totally useless. Right bypass also useless. Native right coronary is 50% blocked. I have been told that I had premature bypass to begin with which left me with constant procedures because I had good blood flow before bypass. Are there any other options available there, that are not here in Florida. They do not do radiation here. What are the side effects and success rate. I am a female 54 years of age, this started at age 51. Thank you for your help.

[Cleveland Clinic, MD]

Dear  Penny,
Topic Area: Restenosis
Recurring arterial blockage  and the chest pain that accompanies it is a difficult and frustrating issue for both patient and doctor.  However it can usually be treated through a combination of medical and interventional  therapy.  
The pain from blockages is due to a supply and demand mismatch in the blood flow to the heart.  The two treatments are to increase the supply (nitrates such as nitroglycerin or long acting nitrates like Imdur increase blood flow, calcium channel blockers such as Norvasc prevent spasm, angioplasty and bypass surgery are all options) or to decrease demand (beta-blockers and calcium channel blockers decrease the work the heart has to do).    In addition anti-platelet drugs such as aspirin decrease the risk of blood clot forming at the point of blockage and a modification of diet and lifestyle decrease the formation of new blockages.  Reducing cholesterol through diet and drugs is also important.
Interventional procedures  include percutaneous methods (with a catheter) and surgical methods (i.e. bypass surgery).  The classic percutaneous method is balloon angioplasty where a small balloon is inflated inside the artery causing fracture and opening of the blockage.  With balloon alone about 30% of blockages recurred leading to the development of newer techniques such as stents.  A stent is a small wire mesh that is designed to "hold open" the artery after a angioplasty.  Stents have cut down the rate of restenosis (recurrent blockage) by about half but there is still a significant rate of return.  Newer drugs are being used to help decrease this rate even further.  A rotoblader technique uses a small "drill bit" to remove the blockage in the artery and is favored by some cardiologists.   In-stent radiation is an experimental technique that shows promise in reducing even further the rate of restenosis.  During the angioplasty procedure a radioactive material is placed in the stent at the site of blockage.  The radioactivity decreases the rate at which a blockage can reoccur.   Trials are currently underway at the Cleveland Clinic examining this new procedure.
Surgical bypass has now been used for over 30 years.  A vein or artery graft is used to "bypass" or go around the blockage in the artery.  Arteries tend to have better outcomes than veins lasting up to 20+ years often.  Surgery is limited to arteries that have a good place to insert the graft.  Although it is routine surgery is is still a major operation and not everyone will be able to tolerate the procedure.  Subsequent bypass surgeries or "redo