469720?1388149949
Lee Kirksey, MD  
Male
Cleveland , OH

Specialties: Peripheral Arterial Disease, PAD

Interests: vascular, specialist, treatment options
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The role of coronary angioplasty and stenting

Jul 06, 2008 - 2 comments
Tags:

angioplasty

,

Stent

,

Cardiac catheterization

,

Heart Attack

,

Angina

,

Heart Failure

,

Congestive Heart Failure



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There are frequent questions being asked about the various treatments for coronary blockages. The appropriate treatment is dictated by the location of the blockage, the severity, the symptoms/ if any that the patient presents with and the medical condition of the patient

The options generally include medical treatment with cholesterol reduction, traditional open heart bypass, minimally invasive and robotic assisted coronary bypass. Percutaneous options for treatment include angioplasty often with stenting. A large number of people undergo stenting because of its minimally invasive benefit

Recent questions have arisen regarding the benefit of angioplasty and stenting versus medical therapy in patients who have stable and asymptomatic coronary artery disease.  That is a person without angina, congestive heart failure or other acute heart symptoms.

These studies suggest that for people with asymptomatic, stable disease angioplasty and stenting does not reduce the chance of heart attack or death to any greater degree than aggressive medical therapy. So although the stents increase blood flow immediately and over a short period of time, the benefits diminish over time as the stents begin to develop blockages themselves. This raises the question should more careful consideration be given to treating more people with aggressive medical therapy instead of stents if they have no acute symptoms.

Furthermore, evidence exists that a small percentage of drug eluting stents have a propensity to occlude at a much earlier rate than "bare stents" and these occlusions may occur at periods well after stent placement. this occurs because the medication that prevents scar tissue from developing (which is why the stents theoretically are beneficial) also leaves the stents surface exposed and prevents the develoment of a protective coating that occurs with "bare  stents". This leaves the stent exposed and increases the chance of stent occlusion by the body's natural clotting mechanism

So I think that its very important to have a conversation that includes all of these options including medication as the treatment strategy without stenting.

http://www.nytimes.com/2007/03/27/health/27stent.html?ex=1332734400&en=df83fb632f1ca6ac&ei=5124&partner=permalink&exprod=permalink

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by newgirl2708, Jul 12, 2008
Dr. Kirksey,
Good Morning, I am Newgirl from the substance abuse forum and am going through the process of finally coming clean off of pain killer addiction for the better part of 15 years. I am in terrible health however reversing it since March of this year with my Dr.'s help. I am doing the Mediterranean diet, I do my treadmill twice a day, 20 in a.m. and 40 in p.m. I have lost 31 lbs since March.  I have high blood pressure and take lisinopril 20 mg a day and it's under control. My question to you is I have relapsed many times and when I do notice minor swelling in my head and neck. My neck cracks all the time, you know like your knuckles do when they fill up with water...my sunglasses are snug even. Not the lower half of my body, but the top half seems to have 'water weight gain'. I have poor circulation, but like I said I am working diligently every day on this. Can you tell me what's going on? I scared to investigate further, but will. I am a work in progress and serious about getting better.
As a matter of fact, I'm headed for that treadmill right now..
Thank you for your time and consideration,
Newgirl

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by liz7777, Jul 16, 2008
HI my name is liz im 30 years old im having almost the same problems its started after a workout that i started having this server dropping in the back of my head it hurt so bad that i was able to feel the blood bumping true my head i dont know what could be wrong i do have hyperstation for the last 9 years and when i checked my blood pressure today it showed it that it was pretty high 159/109 and i even took my blood pressure meds a hour before i took the test what can be wrong with me im still having pressure in my head even after taking Advil today can anyone help me please


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