stent

[Cathy971]

Can the left circumflex artery be stented?


This discussion is related to Circumflex artery calcium -versus stress  ECG ..

[kenkeith]

QUOTE: "After a 1 ½ years of thinking it could never be opened this doctor opened it very quickly.  Unfortunately I had further progression in the mid LAD and D2 and D3 and circumflex".

There is a medical school of thought to open a vessel that is/has been totally blocked can be risky.  When the system has compensated and adjusted to the long standing blockage, to open the occlusion can cause decompensation and affect perfusion with other vessels due to the change of intra vascular pressures, causing the blood to flow into areas of less resistence.

[ed34]

Have you taken all the steps to lower your risk factors? It appears that the disease is not slowing down. Do you smoke? are you eating a healthy diet? exercising as much as possible? I know it's difficult to exercise at the moment, but even a very gentle walk is so beneficial. Is your cholesterol within limits and your blood pressure? are you avoiding stress as much as possible?
I'm not pointing the finger at you, but a lot of people think they can have a stent popped in and that's it, back to normal. You need to establish as many risk factors as possible and make big changes. It took me two years to control mine, and I tried everything on the list. A year ago, stress was added and I realised I had been under a lot of stress. I now avoid it and see things a lot less seriously. Tomorrow will come no matter how much you worry about it. So, I've learned to chill and the last 3 angiograms have shown no more progression of the disease. In my various admissions to different hospitals I found stress to be more common among CAD patients than I had thought. None of them were overweight, most had never smoked, none had bad diets and most had normal cholesterol, some even had low cholesterol. They had ALL had stressful lives in the past few years. When you go to the Doctor for a blood pressure check, they let you sit there and relax for a while and a lot of the time the results look fine. It's a shame they can't run around with you during your daily routines and check it. Mine would have been off the scale with the stress I had at home and work.

[samc0430]

Thanks for the responses.  
I have a follow up next week with my regular Cardiologist.  I am going to get a clearer understanding why it had to be done at a separate time. The block in the circumflex is 80%. The doc who performed this recent angioplasty is actually one of the top angioplasty doctors in the country.  (Same Hospital that Clinton just received his stents.) I also had a 100% blocked lower LAD which I walked around with for the past year with pain symptoms. In July 08 a local doctor attempted to open it but ended up dissecting my artery.  After a 1 ½ years of thinking it could never be opened this doctor opened it very quickly.  Unfortunately I had further progression in the mid LAD and D2 and D3 and circumflex.

[kenkeith]

About 6 years ago, I had stent implant in the RCA, and a 72% occluded circumflex was not stented.  Several weeks later, the interventional cardiologist wanted to do another angioplasty and stent the circumflex.  I asked why now?  I had no symptoms!!  In his broken and difficult to understand English gave an answer that was really not an answer.  I never consented and about month later he left the state.  And I have completely occluded LAD that has a natural bypass developed to compensate and feed the deficit location.

My current cardiologist has never suggested I have a stent for any occlusions, and there has been many tests.  I have been successfully treated with medication, and only have some angina (chest pain) when working out at the gym...I take a nitrate (dilates vessels as would a stent) prior so it is not problem nor a concern. There are guidelines by AAC and AHA that occlusions less than 70% should not be stented but treated with medication...there are exceptions.

You should think of getting a second opinion.  At least get a good answer from your current cardiologist and a response from you would be of interest to this forum.  

[ed34]

It may have been that you had been on the angio table for a long enough period as it was. I wouldn't have thought the LCx was a very difficult artery to deal with in angioplasty, but I believe it is with bypass surgery because the surgeon has to get under the heart. I don't think cardiologists like to do the circumflex and LAD at the same time because they both give oxygen to the left side. If they treat both and problems occur in both vessels, it's goodnight. So I think they let the work settle and make sure things are stable before doing the other vessel.

[samc0430]

2 weeks ago I received angioplasty in 4 locations and had 3 stents put in.  LAD, D2, D3 arteries.
I also have a blockage in my Left Circumflex and was advised by the doctor to come back in 4 weeks to receive angioplasty and stent in that location. I am not 100% why the circumflex has to be done separately but I assume it has something to do with the location which is on the back/side of the heart compared to the LAD which is in the front.