Bypass or Drug Therapy

[tsb627]

Six years ago my husband had a stent placed at the top of the LAD, he had restenosis in 6 months, they did radiation therapy and placed 2 more stents.  6 monhs later he had another stent and then in a month  2 two more.  A couple of them they said artery was 60 or 70% but while they were in there they decided to stent it in one place he was having spasms.  The last 2 were des.  About 4 weeks ago he started having some chest pain on exertion but it would usually go away so he wasn't worried at first, last week they got worse he was scheduled for stress test, he couldn't finish that they did a cath and most of his lad was blocked, Dr.  said he went up to 22 atmospheres? to ballon it out but still not very good flow.  His right coronary artery is actually 20% better than when his first stent was put in.  Dr. didn't want to do a bypass because of all the stents (said they had grown fast?) and he put another stent in at the top of lad.  He's was on Zocor 10 mg., Tricor, Norvasc 5 mg, and Plavix.  They've now added Carvedilol 3.125 2x/day and Lisinopril 2.5mg.  Ejection is 55%, Cholesterol-119, LDL-64, HDL-29, and Triglycerides-131.  BP is usually 120-130 over 80 pulse 60.  My husband is 60 years old, no other health problems,does chew some snuff, 5 ft. 10in  209 lbs.  No diabetes.  The dr. seemed very discouraged and couldn't understand all this blockage after 5 years, what do you think is wrong and do you agree he shouldn't have bypass?

[Gerard88]

Hello

My name is Gerard, living in Sweden, 67 yrs old and landed in our towns hospital
after several Angina attacks, the last one did NOT dissapear.
This was Sept. last year. Because 3 of my coronary arteries
were clogged, one, the right, totally, the doctors recommended
bypass surgery. But, many years ago (1996) I allready read
Dr John Mc Dougalls book about alternativs to open heart surgery.
So I refused, I ordered Dr Caldwell Esselstyns latest book about
preventing and reversing heart disease and started immediately
his recommend diet. You have to be very motivated to follow this
100% and I was, I have still a 12 year old daughter at home
and a lovely wife (4 grandchildren) a lot to live for!!
Anyway in December my Angina (coming up after maybe 200 mtr
walking ) dissapeared suddenly, I could walk, not to fast, for
hours.I still take Ramipril, Trombyl and 25 mg Atenolol but hope
to finish in near future with these because of very good values
of both cholesterol and bp.My wife, working as a nurse with
stroke patients can tell you that many people regret not to
choose lifestile change when there still is time! I sincerely hope
your husband will make his lifestyl change in time.

All the best!
Gerard

[Lee Kirksey, MD]

Hello
Thats a very discouraging story. Youre husban has a number of risk factors for heart disease and they seem relatively controlled. He is overweight and he continues to use nicotine. It would be impossible for me to make a judgement about the decision to do open coronary bypass based upon this brief description and communication between you and I. Im not sure where you live, but my suggestion to you would be to find your regional expert center in cardiovascular disease, usually a university, gather your husbands records and films and seek the opinion of the expert in cardiovascular surgery.

Recent studies have demonstrated that coronary stenting may not be as durable as once was thought and particularly for relatively young people, open revascularization is more durable and long lasting. Hopefully, your husband had been evaluated by a surgeon at some point in this process to determine if surgery would be a better option then stenting. In our hospital, we approach each patient with a multidisciplinary approach so that experts with each type of procedure come to an agreement about which procedure should be used. sometimes, it's it not easy to reach that conclusion

In this case, I think that you need another set of eyes to look at the problem. Good luck and God Belss