Aa
Diagonal Stentiing
How can stenting the Diagonal compromise the LAD. My father just had a stent put in his diagonal. He is still having chest pain and tightness. Could this stent be compromising his LAD? At the time is was placed, he had been admitted to the ER and went straight to cath.
This discussion is related to Chest pain and Diagonal Branch blockage.
This discussion is related to Chest pain and Diagonal Branch blockage.
QUOTE: "Reperfusion injury happens to tissue that has been totally starved of oxygen, then it is suddenly returned."
>>>>>Yup, that is what has been said. Stenting can cause a problem downstream to other vessels, and to a bifurgated vessel sharing the same source of blood supply based on the hemodynamic physics.
>>>>>Yup, that is what has been said. Stenting can cause a problem downstream to other vessels, and to a bifurgated vessel sharing the same source of blood supply based on the hemodynamic physics.
But on the other hand, there are other reasons for chest pain after stenting as in my case. I didn't have a problem with the spasms until after the stents. Could there be a connection in this? The heart spasms are hard to differentiate from the chest pain of a heart attack. Going straight to the cath lab seems to have become the protocol with most hospitals now if you come in having a heart attack or blockages are detected.
Reperfusion injury happens to tissue that has been totally starved of oxygen, then it is suddenly returned. Such as acute heart attack. In the majority of cases involving 70% blockages or more, there is sufficient blood in the vessel to prevent ischemia. Otherwise, it would be true to say if a patient is suffering chest pain at rest and takes nitrates, they are causing reperfusion injury. It would be the same thing, getting more blood to a defecit area. My LAD was totally blocked at the top, and I went through all this with my cardiologist. My vessel had somewhere between 5-10% of blood flow given from the lower end, through cross feeds that had adapted. It was enough to keep tissue alive and so reperfusion injury would not come into it.
QUOTE: "To put it in real basic terms, if a Cardiologist sees a big blockage, he immediately believes this must be the culprit and the smaller ones are no bother. He stents the largest one, leaving the small ones, believing all is solved".
Interesting but there could be another reason. Hemodynamics (blood flow pressure and velocity, shear stess, blood flow turbulance, etc.) can be the underlying phenomonon for the problem cited.... At a bifurgated junction the blood flow is divided from the same source. A blockage in the diagonal and a blockage in the other vessel that was sharing a blood supply can be compromised. By opening one or the or the other blockage will reduce the gradient pressure of the newly opened or enlarged vessel lumen and this will increase the velocity and blood flow through that vessel and that could certainly reduce velocity and blood flow through the other vessel. Blood flow as with any other fluid will flow a course through the area of least resistance...
I have a totally blocked LAD and 70% blocked circumflex. To reopen the the LAD could cause a serious problem, the result could heart cell damage due to reperfusion. "Reperfusion injury refers to damage to tissue caused when blood supply returns to the tissue after a period of ischemia. The absence of oxygen and nutrients from blood creates a condition in which the restoration of circulation results in inflammation and oxidative damage through the induction of oxidative stress rather than restoration of normal function."
Interesting but there could be another reason. Hemodynamics (blood flow pressure and velocity, shear stess, blood flow turbulance, etc.) can be the underlying phenomonon for the problem cited.... At a bifurgated junction the blood flow is divided from the same source. A blockage in the diagonal and a blockage in the other vessel that was sharing a blood supply can be compromised. By opening one or the or the other blockage will reduce the gradient pressure of the newly opened or enlarged vessel lumen and this will increase the velocity and blood flow through that vessel and that could certainly reduce velocity and blood flow through the other vessel. Blood flow as with any other fluid will flow a course through the area of least resistance...
I have a totally blocked LAD and 70% blocked circumflex. To reopen the the LAD could cause a serious problem, the result could heart cell damage due to reperfusion. "Reperfusion injury refers to damage to tissue caused when blood supply returns to the tissue after a period of ischemia. The absence of oxygen and nutrients from blood creates a condition in which the restoration of circulation results in inflammation and oxidative damage through the induction of oxidative stress rather than restoration of normal function."
In a word. "no".
Unless the stenting was on the bifurcation of the diagonal/lad, in which case some swelling may have occurred, which would be temporary. I think it more likely that some disease was seen in the LAD but not considered as severe enough for stenting, and taken for granted that medication would help.
I think that angioplasty has gone totally out of control and the tools which can give a perfect outcome a much higher percentage of the time have been available since the invention of angioplasty. A special wire with a sensor on the end called an FFR (Fractional Flow Reserve) is passed through the blockage and it measures both flow rate and pressure as it goes, showing the results to the Cardiologist. You can see instantly if the blockage is causing any issues to the function of the heart. I've had 6 or 7 angiograms now, and not once has this been used. To put it in real basic terms, if a Cardiologist sees a big blockage, he immediately believes this must be the culprit and the smaller ones are no bother. He stents the largest one, leaving the small ones, believing all is solved. The FFR shows this ideology to be wrong. It has proved time and time again that in many cases the large blockage is not the culprit at all, it is the smaller ones. So patients end up with stents they don't need, and they feel no better.
Next time you see your cardiologist, ask did he use FFR and if not, why not, when it has been around for over 30 years and gives a much more accurate understanding of the patients problems.
Unless the stenting was on the bifurcation of the diagonal/lad, in which case some swelling may have occurred, which would be temporary. I think it more likely that some disease was seen in the LAD but not considered as severe enough for stenting, and taken for granted that medication would help.
I think that angioplasty has gone totally out of control and the tools which can give a perfect outcome a much higher percentage of the time have been available since the invention of angioplasty. A special wire with a sensor on the end called an FFR (Fractional Flow Reserve) is passed through the blockage and it measures both flow rate and pressure as it goes, showing the results to the Cardiologist. You can see instantly if the blockage is causing any issues to the function of the heart. I've had 6 or 7 angiograms now, and not once has this been used. To put it in real basic terms, if a Cardiologist sees a big blockage, he immediately believes this must be the culprit and the smaller ones are no bother. He stents the largest one, leaving the small ones, believing all is solved. The FFR shows this ideology to be wrong. It has proved time and time again that in many cases the large blockage is not the culprit at all, it is the smaller ones. So patients end up with stents they don't need, and they feel no better.
Next time you see your cardiologist, ask did he use FFR and if not, why not, when it has been around for over 30 years and gives a much more accurate understanding of the patients problems.
Have an Answer?
You are reading content posted in the Heart Disease Community
Is a low-fat diet really that heart healthy after all? James D. Nicolantonio, PharmD, urges us to reconsider decades-long dietary guidelines.
Can depression and anxiety cause heart disease? Get the facts in this Missouri Medicine report.
Fish oil, folic acid, vitamin C. Find out if these supplements are heart-healthy or overhyped.
Learn what happens before, during and after a heart attack occurs.
What are the pros and cons of taking fish oil for heart health? Find out in this article from Missouri Medicine.
How to lower your heart attack risk.
