Angioplasty vs Bypass Surgery - Pros and Cons

[Cody]

Dear Physicans at Cleveland,
During a cardiac catherization one major blockage of 90 to 95 per cent was found in the LAD and two less significant blockages were found on the right side(one of 25 per cent and one of 30 per cent).  In your opinion what would be the best course of action (angioplasty or bypass surgery) to correct the blockage in the LAD?  What are the pros and cons of both of these procedures as related to this situation?  Also if the angioplasty option was chosen and proper life style changes (low fat diet, daily exercise, etc.) were adhered to, how long can a successful angioplasty be expected to last?
Thanks - Tim

[TD1942]

A related discussion, abnormal heart rate was started.

[Burt Jabri]

July 15, 2000


A Friend of mine Robert Warrick had a hear attack a few weeks ago and was treated with medication and diet. He has had an angiogram and was found to have three blocked arteries. His doctor is recommending By-Pass surgery. However, there news reports that recommend angioplasty instead of surgery.

Our questions are what are the merits and disadvantages of both and which is the more vavourable method. We were given conflicting opinion here in Toronto and would like to hear from you.

Many thanks.

Burt Jabri

[Burt Jabri]

A Friend of mine Robert Warrick had a hear attack a few weeks ago and was treated with medication and diet. He has had an angiogram and was found to have three blocked arteries. His doctor is recommending By-Pass surgery. However, there news reports that recommend angioplasty instead of surgery.

Our questions are what are the merits and disadvantages of both and which is the more vavourable method. We were given conflicting opinion here in Toronto and would like to hear from you.

Many thanks.

Burt Jabri

[Burt Jabri]

A Friend of mine Robert Warrick had a hear attack a few weeks ago and was treated with medication and diet. He has had an angiogram and was found to have three blocked arteries. His doctor is recommending By-Pass surgery. However, there news reports that recommend angioplasty instead of surgery.

Our questions are what are the merits and disadvantages of both and which is the more vavourable method. We were given conflicting opinion here in Toronto and would like to hear from you.

Many thanks.

Burt Jabri

[Darla Davis]

My husband just had stent and angiopasty done with 3 stents.  He had a 99% blockage. It has come to my attention that the medication he is using called Plavix has concerns to the medical community. He is touse the Plavix for 1 month and then discontinue use.  He is on a blood pressure medicine along with aspirin daily to keep his blood pressure in check.  I am concerned about the affects plavix has been reported to do to some individuals who have used it.  Any comments that may relieve my mind as to the danagers of this medicine?  Also..how does one know the proper cholestrol count for a given individual? What is the acceptable # for good cholsetrol and the non acceptable # for the bad cholestrol?  Thank you in advance for your opinion.

[Carithers]

Please explain in layman terms what Percutaneous transluminal coronary angioplasty is and involves.                                                             Thanks

[Z, Dutkiewicz]

DEAR PHYSICIANS,
      
        I HAD ANGIOPLASTY DONE INCLUDED STENT,RIGHT CORONARY
ARTERY THAT WAS 95%BLOCKED.THIS WAS DONE 12/23/97. ON THE
FOLLOWING DAY,I WAS RELEASED TO GO HOME, NO COMPLICATIONS.
FOR THE LAST 2 YEARS,AFTER MANY VISITS WITH MY FAMILY INTERNIST
AND MY CARDIOLOGIST,SURGEON,INCLUDED:3 THALLIUM STRESS,DUAL
ISOTOPE,EXERCISE THREADMILL TESTS,PER YEAR -ALSO ECHO STRESS,
WHICH ALL WERE FOUND TO BE NORMAL,WITHOUT ANY EVIDENCE OF
ISCHEMIA.
        AFTER ALL THIS,PLUS MANY BLOOD TESTS,FOR CHOLESTEROL,
WHICH AT THE PRESENT TIME IS 165.I STILL AM HAVING CHEST PAIN
OCCASIONALLY,THAT CONTRIBUTES TO FREQUENT BOUTS OF ANXIETY,
AND LIGHTHEADEDNESS.
        I REALLY DO NOT KNOW WHAT TO DO ANY MORE.ANY HELP WOULD
BE APPRECIATED.
                             THANKYOU,
                                      ZBIGNIEW

[Z, Dutkiewicz]

DEAR PHYSICIANS,
      
        I HAD ANGIOPLASTY DONE INCLUDED STENT,RIGHT CORONARY
ARTERY THAT WAS 95%BLOCKED.THIS WAS DONE 12/23/97. ON THE
FOLLOWING DAY,I WAS RELEASED TO GO HOME, NO COMPLICATIONS.
FOR THE LAST 2 YEARS,AFTER MANY VISITS WITH MY FAMILY INTERNIST
AND MY CARDIOLOGIST,SURGEON,INCLUDED:3 THALLIUM STRESS,DUAL
ISOTOPE,EXERCISE THREADMILL TESTS,PER YEAR -ALSO ECHO STRESS,
WHICH ALL WERE FOUND TO BE NORMAL,WITHOUT ANY EVIDENCE OF
ISCHEMIA.
        AFTER ALL THIS,PLUS MANY BLOOD TESTS,FOR CHOLESTEROL,
WHICH AT THE PRESENT TIME IS 165.I STILL AM HAVING CHEST PAIN
OCCASIONALLY,THAT CONTRIBUTES TO FREQUENT BOUTS OF ANXIETY,
AND LIGHTHEADEDNESS.
        I REALLY DO NOT KNOW WHAT TO DO ANY MORE.ANY HELP WOULD
BE APPRECIATED.
                             THANKYOU,
                                      ZBIGNIEW

[George]

Zbigniew:

I noticed your question, and I do not think you will get a response because you posted your question as a response to someone else's question--you should go the main heart forum page and repost your question.

[Z, Dutkiewicz]

Dear Physicians,

    
                                              
           I am still waiting for a comment from you, regarding
comment I made on Tuesday,March 07,2000.I hope you will answer
my inquiry.Please forgive me for being so inpatient.
                                            THANKS,-ZBIGNIEW

[Zbigniew Dutkiewicz]

DEAR DOCTOR I had angioplasty performed with Stent, right coronary artery 95% blockage,also two other arteries ,one 30% ,the other 45%.These two were left alone.This was done, 12/23/97.On the following day I was released to go home.For the last two  years after many followups with my family internist,and my cardiologist,plus two or three Thallium stress,dual Isotope,exercise tests per year, all were found to be normal, without any evidence of stress induced ischemia.I still have occasional chest pain,that contributes to frequent bouts of anxiety, lightheadedness,.Ifeel awfully disgusted and helpless. Any ideas!   THANKYOU.

[Christine]

Hi Tim,
I can't tell you anything about bypass, but, I can speak for angioplasty. My husband had a 95% blockage in what they refer to as the widow maker artery  and they put a stent in his artery to hold it open and he was home in 2 days and you would never had known he had a problem at all. No scars, no down time and he was jogging that same week. Hope I helped a bit.
Christine

[CCF CARDIO MD - DLB]

Either angioplasty or surgery are reasonable options for this situation. My exact answer would depend on the location (within the LAD) and type of blockage. Not every blockage, for technical reasons, is ideal for angioplasty. If based on review of the angiogram, the blockage could be treated with angioplasty, this is what I typically recommend as the first line of action. About 80-90% of the time, an angioplasty (of an appropriately selected blockage) is sufficient treatment, but 10-20% of the time the blockage comes back. A repeat angioplasty can then be performed, or surgery can then be used. You will need to make appropriate lifestyle changes anyway, to keep the rest of your coronary arteries from developing more blockages.