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CABG following failde stent

patient backround
kat, diagnosed with a 95% occluded left main coronary artery, had stent placement. lesion was underestimated, stent too short, resulting in pre and post stent stenosis. doctor advised that protocol in this scenario is CABG. this was performed a few days, single mamary graft, 5 days icu post op with much bleeding. kat continued experiencing angina pains, along with pleural effusion, collapsed lung etc. another angiogram was performed after 2 weeks, and bypass functioning only 10%. second stent placed, into first, effectively lengthening it, and heart irrigated for the first time since initial diagnosis, 10weeks earlier.

Question:
is the protocol after a failed/inapproprite stent placement systematically bypass surgery?
7 Responses
976897 tn?1379171202
well I'm not a cardiologist but when reading the first part of your post, I was wondering why another stent was not used. Logic never seems to present itself with experts.
Mind you, common sense cannot be taught and I often believe the only qualification
required for many doctors is a very good memory to remember book after book.
Are there protocols or does the cardiologist make a decision at the time based on
the condition of the patient? With so many different possibilities I wonder if protocols
could even be produced.
Avatar universal
thanks ed, it is all a bit frightening when one starts to factor logic into the equation!!
it is the one moment that i regret, ie not having sought multiple opinions at that point, could have avoided much trauma...also realising that doctors can easily push responsibility onto patients for things going wrong..she blocked the stent, or rejected that bypass graft etc...how we gonna check, open her up again??
976897 tn?1379171202
Then again, how many times in life do we wish we could wind back the clock and make
a different choice. I experienced more than one mistake by experts, two of which very
nearly killed me and cardiologists couldn't understand why I was so cautious about
everything. I refused lots of procedures and in the end told them what I wanted. Every
cardiologist refused my option and now two years later a cardiologist at a well known
research centre has agreed with my logic and agreed to perform my requested procedure. We have to remember that doctors are human also and are prone to mistakes, no one is perfect.
Avatar universal
curiosity getting the better of me..trying to imagine what cardiologists would not do, and you waited 2 years to find someone who would?
my worry with kat is that if we really did need the bypass, and today do not have it, are we in for more of the same mission down the line...
976897 tn?1379171202
Basically my left artery has a long solid blockage at the top. I set on a quest to find a
cardiologist who would drill it out and place a stent. I know the blockage is on a slight
curve and fairly long, making it more risky, but this is the best way I could see the artery
being put back to normal. The closer you get something to the way nature intended it, the better it will work is my motto. Cardiologists argued and would not perform this procedure and were more than willing to perform a triple bypass. I had no option in the
end and agreed but told them it wouldn't work in a million years. They dismissed my reasons and stated I would have a good left artery for the rest of my life.
The surgeon used an artery from the chest and grafted it to the wrong place. He grafted it
directly over the long blockage, which means it is useless. The two veins were grafted lower down and collapsed after three months. Now my left artery is narrower than ever.
I was offered a retry at a bypass, a transplant and various other methods including killing some heart tissue to kill the angina symptoms. Now a cardiologist has decided he can
drill out the blockage and still all other cardiologists are disagreeing with him. He works
in imperial college research and is known internationally. If he is successful in this case, he will have pioneered a way to open the top of a left artery, which is the usual site opted
for a bypass. I have this procedure in a couple of weeks.

If you want some advice, listen to your cardiologist but always have a second one at hand to offer a second opinion, preferably at a different hospital. Talk to your GP and
ask anything you are unsure about. Now you have to take all three dialogues and make
sense from them, interpreting the differences. You can usually come up with the logical
answer. The hardest part after that is getting a cardiologist to actually listen to you. Unfortunately too many see normal people as mere uneducated morons who can't possibly know anything about anatomy. I remember saying "oh, didn't they teach common sense at your medical school?" When I get angry I simply knock them down a peg or two so we are on the same planet. Obviously not all are the same, but many are.
976897 tn?1379171202
Just to add.  If you decide on a bypass, you can try and ensure longer lasting results by
ensuring they check the condition of the arteries in the chest. If they are in good condition they will usually last the remaining natural life of the patient. Veins do not have
such a life span and tend to collapse. Veins last anywhere between a couple of months
to 15 years. The odd few have lasted a bit longer, but they are far between.
Avatar universal
Ed, thanks for sharing that with me...your advice on alternate opinions is the way to go, and any developments in kat's condition will be handles this way.
as kat has already had a failed bypass, and the second stent seems good at the moment, we prey that this all ends here.
wishing you positive forward looking energy, faith and all the best for your artery clean out and stent. visualise that blood flowing freely!

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