Failed Echo Stress after Bypass

[Tarheelguy1967]

I am 42 and had double bypass of my LAD about 10 months ago.  They used one mammary and a radial to do the bypass.  My problem before bypass is that I had 5 stents (4 in the LAD and one under the 4 to close the gaps and reopen them after restenosis), but apparently I develop scar tissue or block up pretty agressively.  Based on my symptoms, my cardiologist had me come in for an echo stress test.   The test showed abnormality in the LAD area where I had my bypasses, so they've scheduled me for a heart cath (my 12th in the last 3 years) for Tuesday a.m.  As a result, I'm hoping for some advice before having to go in for the heart cath.  I have several questions, and appreciate any advice/info you can provide.
(1)  What could cause the abnormality in my echo stress?  Could my bypass be failing this soon?
(2)  What are my options if they find something?  I have no desire to have additional stents.  My life has never been the same since I had the first stents - 3 during my first cath - put in.  I've blocked up very quickly, and have had to have so many heart caths, nuke stress tests, x-rays, etc that I'm surprised I don't glow in the dark by now.
(3)  Is there a possibility I'd have to endure another bypass?  The first one was hard.....if necessary, just hope I can muster the internal fortitude to endure it again.  
(4)  I saw a book by a Dr. Caldwell Esselstyn about reversing heart disease - could it be better to seriously alter my diet rather than have more stents put in that, by past experience, will only block up in a matter of months?

Thanks for any advice you can provide.....I'm in a bit of a confused state at this point.
V/R
Mike

[Tarheelguy1967]

I am having symptoms, which is why they did the echo.  I have had similar chest pressure, back pain, and shortness of breath as I had prior to the bypass for the last two weeks.  Good to know that the test isn't accurate regarding the area bypassed, but given the symptoms I am still concerned.  Hope the cath is normal - not sure what to do if not.  I will tell them not to stent anything if they do find something, and I'll try the meds.  Thanks for the advice.

[Cleveland Clinic]

1.  The first questions that needs to be asked is whether or not you are having any cardiac ischemic symptoms.  If you've never had  ischemic symptoms before than the stress test was indicated, but if you had chest pain or chest pain equivalent in the past, and now you are true chest pain free, then the stress test is not indicated and I would not recommend any further testing.  If you never had any symptoms and the stress test is positive, you should have the catheterization, however, keep in mind that stress tests aren't very accurate in pts with previous bypass surgery.  It is highly likely that your catheterization will be normal and nothing else will have to be done.  LIMA grafts last for at least 10 years.  Radial grafts aren't very good.
2.  I think that a stent should only be put in if there truly is a severe lesion in the proximal coronary arteries.  Everything else should be treated with medications.
3.  I don't think you will need another bypass, but if necessary, this has been done before.
4.  Diet and other risk factor modifications are key to treating CAD.  This should be the primary goal.  I would definitely recommend focusing on that as much as possible.