70% Artery Blockage !

[Fariha89]

Hi,
My uncle just had a angioplasty & it went fine he was there in the icu for 48 hours then he was sent home. After 4 days he had a heart attack again because there were some blood clots blocking the artery which were removed when he was taken to the hospital the second time. He was then there in the hospital for 12 days because they were givin him blood thining medications. He came home after that now hes taking some blood thining medications, omega3 fish oil tablets, taking care of his diet but still has chest pain.
He recently went to see the doctor & they found out that he has 70% blockage in one artery & 20% in one. After this detail I just wana ask can medicines cure 70 % blockage ? Or should we go for another angioplasty or is there any other solution ?
Thank You !
Fariha from Pakistan

[ChatterAlly]

I have had 3 stents put in the RCA and still suffer with chest pains.  I never had these chest pains before the stents.  I had some discomfort and shortness of breath that sent me to the ER in 2004.  That's when the first stent was put in and I started having the chest pains that I have now. Since then I have had 2 confirmed heart attacks.  Recently I was diagnosed with coronary artery spasms and was told I had a 50% blockage that would require bypass if the chest pains didn't get any better.  I am trying the meds first.  I will have the bypass only as a last resort. I am now on the beta blocker, ace inhibitor, calcium channel blocker, statin & 2 forms of nitrates.  Let's hope that your uncle and I can get some relief without all that bypass misery.  Take care, Ally

[ed34]

I am shocked that he had a clot form in the stented area. Was it a drug eluting stent and was he on plavix with aspirin?
A 70% blockage can certainly be stented, in fact, as Kenkeith stated, this is the minimum before stenting is even considered. Even a 100% blockage can be stented.
A bypass does not remove all blockages. In fact, the blockages remain where they are and extra blood vessels are stitched in the area past the blockage. This is why it's called a bypass and not a removal.

[larry71]

For Fariah and everybod's info,

you can read and download lot of materials from the below link....especially having a healthy diet for people with heart related disorders ....

http://www.bhf.org.uk/living_with_a_heart_condition/top_bhf_publications.aspx

[kenkeith]

Quote:  "Even a 100% blockage can be stented".

>>>>Is that angioplasty approaching from the distal side of the occlusion?  

[ed34]

That depends on the easiest approach. In most cases it would have to be the proximal side, ie nearest the source of flow. In my case it was believed there were 2 possible approaches to removing the blockage. 1 was to enter through the Lima which would have resulted in being in a tiny clear trough in the middle of a blockage 2cm either side. However, it was decided that the angle at the anastomosis was too great. Access from the left main stem was the final decision. Rotablation of total occlusions in coronary arteries in St. Marys hospital London are very common, as is the use of laser. However, there has to be a lot of consideration regarding the anatomy of the blockage. Considering a catheter guidewire has to be passed centrally through the blockage to prevent wall damage from the drill, the blockage has to be on a fairly straight section and has to be quite short so the other side can easily be observed. There is also a bigger problem if the blockage is tight against a bifurcation. Mine was about 5mm in from the bifurcation of lad/circumflex.
In St. Marys the use of angioplasty over bypass is increasing all the time due to long term outcomes and trauma.
Actually the procedure used on my blockage was quite intriguing but also nerve wrecking to watch. You seem to be engrossed in the process, but keep reminding yourself "hang on, this is inside me, one slip and I will die". They had to chip away at the hard cap on the end of the occlusion for about 20 mins before hitting soft plaque, so the guidewire could be pushed through. Each tiny piece of plaque was patiently removed from my body which is why it took so long. Once the rotablator went in, whoosh, it seemed to zoom through destroying everything in its path. A tiny net was opened at the end of the guidewire to be a safety net, catching any possible large pieces. However, no large pieces escaped the drill.
The remainder of the LAD had a substantial coating of plaque and they ran a laser up and down a few times, cleaning it. I passed out from extra medication at that time, but kept waking up to pains when the balloon was inflated. Boy did that hurt. I lost count how many times they used the balloon, but it was for the entire length of the lad.

[kenkeith]

Has consideration been given to the fact that a totally occluded vessel will be fatal unless there is/has been a supply of blood to the deficit area?  And if and because there has been an on going slow process of plaque buildup there has to be another source for the blood supply to the subject area if buildup of plaque is at critical location to avoid an MI or as the plaque is building up there are progressively small areas of the heart that become necrotic from lack of oxygenated blood. It seems reasonable that to open a totally occluded vessel will reduce the blood pressure at proximal side of the occlusion that drives the alternative source of blood that now had been supplying previous area of the blocked vessel.  Do you think there is a possibility that under the circumstance of opening a totally blocked vessel will not now provide an adequate blood supply to the area, and the collateral vessels will also be rendered ineffactive from reduced pressures?