stent vs open heart with rectal bleeding

[BOOPERS11]

Hi  If anyone is able as before to assist with a heart dilema, My question is: I have a blockage somewhere in the area of  the heart { lower descending anterior coronary artery region  } I am an afib patient with high blood pressure, hypertension, diabetic, thyroid and bleeding from the rectum because of hemoroids and have recently failed my stress test and ordered to have an anteriogram in the stent room just in case... I also have a low blood count. They want to place me on plavix for 1 month with the stent but am scared that this will cause severe out of control bleeding...second choice and also my primary care doctors choice is to get open heart surgery so that i would not have to take blood thinners... I also have severe back problems and fibromyalgia... are stents really worth it? I have heard so many negatives on stents and how they have to repeat the procedure  so which of these should i do? will i even have a choice? please reply asap.. Thanks Boopers

[BOOPERS11]

Thank you for your response, My afib is under control for the most part due to high blood pressure medication 320 mg of diovan per day & 160 mg of sotalol per day. As I stated before the rectal bleeding is due to a vein  { hemoroids }which the gi explained is not repairable and if it were the type of insurance I hold refuses to help with that. My cardiologist said at our last session that if i were to start bleeding there they would be able to do nothing about that so that raises the concern of plavix getting that out of control. It seems my cardiologist does not have the patience to explain all this to me in detail so this is much appreciated getting input here by the way so thanks to all who have responded. He especially hates to repeat his self when I try to get him to clarify on specific information which has been a little hard to decifer... sometimes I feel his mind is on his morgages at his vacation sites so who knows? When I did ask what he recommended  his reply was " let me repeat this again " with attitude so I figured this was his way of getting the patient to just be quiet while all knowing says what he says so he could move on to the next room. Just need a little support and understanding  and sure do get more of that here at this forum it seems... thanks again          BOOPERS11 :O )                                                                                                                          

[Flycaster305]

Just a couple of other questions...
I'm guessing that the need of a stent came from a stress test.  It's a far leap from a stress test to bypass surgery.  The stress test can show that there is inadequate blood flow to the heart, but the angiogram will determine the amount of blockage, if a stent or bypass is needed, etc.
ed34 is on the money, you will find a whole lot of horror stories about stents.  I know from my work as a volunteer in a Cardiac Care Coronary Unit that problems with stents are extremely rare, and problems with bypass surgery happen more frequently.  I have eight stents, have had no problems.
Your biggest risk factor with Plavix initially is Hemmoroids, but that can be controlled, but what is your afib situation?
More information will help.  Best wishes.

[BOOPERS11]

thank you for your quick response, The Dr did not say it was an immediate sense of urgency with this. Would a low blood count interfere with going with the stent procedure? My Dr mentioned me going on plavix and staying with my aspirin even though i just had a scope and was found to have rectal bleeding... to correct this would mean a hemoroid operation which my insurance does not cover so insurance kinda plays a role in the decision also. My Dr also says he would go with the bare metal stent  or stents rather than the coated so I could stay on the plavix for only 1 month.... thanks again ed and kenkeith... it is wonderful to have people like you to help with questions like these
                                                                                   BOOPERS11   : )

[kenkeith]

Don't let the issue of plavix be a deciding factor for a stent or a bypass.  There have been many successful interventions without plavix.  I think your doctor to suggest a bypass to avoid plavix is off the chart.  

With a (DES) stent there is dual therapy recommended for up to a year.  This helps a very small percentage (less than 2%) who may have restenosis (another blockage with blood clot).  Lower descending aorta is in the abdominal or chest area and may have other implications that stress the heart such as higher intra-left ventrical pressure that could enlarge the chamber.  

Whether you even require intervention is another question.  What symptoms has your doctor associated with the dx of a descending aorta occlusion?

Thanks for sharing, but you should be given more information to help you make an informative decision.  Did the doctor say if you needed immediate treatment?  Any operations that may cause excessive bleeding would involve being off any anti-platelete medication for at least 6 days...

Regards,
Ken

[ed34]

Stents are very successful indeed in you look at the whole picture. Bypass procedures are far from perfect too, mine lasted 3 months, some last much less and some last many years.
The idea of anticoagulants is to lower the risk of stroke/heart attack. These are also very much risk factors with bypass surgery, indeed, with any surgery. If you are afraid of uncontrollable bleeding, simply request an INR test to see what your clotting factor is. They will then be able to advise you. The internet tends to produce problem cases over successful ones, which is why my Cardio warns me not to accept too much of it. It's like the media, no news is good news.
Stents aren't repeated actually, you would have a lot of trouble removing a Stent without wrecking the artery. In the majority of cases other blockages form elsewhere because the patient hasn't made the effort to change their lifestyle in any way. Stents 'can' block but this is very rare with the newer stents.
You could ask 100 people which they would prefer, stent or bypass, and you would probably have a range of opinions why one should be chosen over the other. Mostly based from experience. My opinion from experience would be have stents because the discomfort from bypass was far higher than I expected for a year and my grafts only lasted three months. I have a perfectly healthy stent which is exactly 4 years old next week. I have 5 others which are now over a year old.