atherectomy

[molzmd]

I had 4 vessel bypass surgery 13 years ago. I had a stent placed on my left subclavian artery (90% occluded) about 3 months ago. I still have pain on my jaws (which is of cardiac origin) after moderate exercise relieved by rest. My cardiologist noted that the bypassed right coronary was somewhat clogged. Grafted left coronary is open and my ejection fraction is about 75%. He is going to put me on Ranexa and see if there is improvement. If none he told mea procedure to clean the right coronary which is so long that putting a stent is not possible because of the lenght of the plaque. I have two questions:

  1. How safe is roto rooter (atherectomy) procedures in general under an experienced physician
   2. Are there eluting stents long enough to place on an atherectomized artery like mine?

Thanks

[erijon]

Thanks Ed.

[ed34]

Have you had a nuclear scan to check the right side of your heart? Not everything is visible on an angiogram. You might be developing collateral vessels which is natures way of bypassing blockages. If this is the case, you wouldn't need intervention. My right artery is totally blocked halfway down, but my body opened natural bypass vessels around the blockage which gives a great flow of blood. Sometimes I wonder if Cardiologists don't give enough time for these to open.It's the variations in pressure across the coronary arteries which promotes the opening of these vessels, and throwing in a stent would prevent it. To me, a natural opening artery with a lining as smooth as glass is far superior to a wire scaffolding which is very rough, promoting the possibility of clots, scar tissue and further plaque.

[molzmd]

Thank you for your input. My cardiologist mentioned only roto-rooter. I am sure he knows about laser. I appreciate your comments.

[ed34]

Hi, A Cardiologist will not attempt the procedure if he feels unsure. The technology is pretty good, it obliterates the plaque. With regards to stents, it took 5 stents to completely line my LAD. They can lay them end to end. Rather than the procedure mentioned, I wonder if laser would be a better option. Before a decision is made, it's vital that the actual composition of the material in the artery is determined. Sending a cutting tool through an artery which is mainly blocked with scar tissue will make, well, let's just say it will be messy. Laser will burn away scar tissue much more cleanly.

[erijon]

Ed34 is really the expert on this treatment. Please go to the heart disease community and post this there. I'm sure he will respond as he has experience with this.

Jon