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1209084 tn?1267371006

How Common Are Angioplasty Failures?

A couple of weeks ago, I was admitted to a hospital to have an angioplasty performed.  I have a strong family history of heart disorders - my mother, sister and brother all have had heart attacks and/or angioplasties).  I have two blocked arteries in my heart - the main one on the left near the bottom of the heart (100 percent blocked) and another a bit higher on the left (95 percent blocked).  The surgeon was unable to place stents or relieve either blockage at that time, and they sent me home with three new prescriptions for Metoprolol, Amlodipine, and Niacin.  My question is, how common is it for an angioplasty to simply be impossible to accomplish?  And can the medication changes I've received clear these blockages and eliminate the need to have an angioplasty at all (with the prerequisite lifestyle changes, which I have started to do)?
21 Responses
367994 tn?1304957193
I was diagnosed with a completely blocked LAD (left descending artery) and  72% blocked circumflex.  For the past 6 years I have been on medication, exercise, proper diet, etc. and there has been no progression....and I feel fine. The totally blocked artery has other vessels that by-pass and feed into the otherwise deficit location.  The 72
%  vessel could be stented but I have no symptoms with medication so no reason to stent.

To be unable to stent an occlusion can be due to the location, too large, totally blocked and unable to work through for an opening.

The totally blocked artery at the distal end may be an area that doesn't require much oxygenated blood and other vessels may have developed to help avoid any serious damage to heart cells..
1209084 tn?1267371006
That would be spectacular news to me if my issues could be resolved with lifestyle changes and medication as yours apparently have been. My cardiac cath was one of the most horrible experiences I have ever had, and I would do almost anything not to undergo that again (not to mention major surgery such as CABG).  Thank you for the information you have provided.
63984 tn?1385441539
What happened during the cardiac cath that made it so difficult?  I've had quite a number of them and they have been quite routine.

I have had eight stents.  I'm one of those that can't seem to develop larger blood vessels that naturally bypass blockages, even though I keep to very tight diet, exercise every day, and take all the good drugs.  I'd certainly encourage that lifestyle, however.  There are a lot of swifter arrows in the quiver than me on this board, so take what I say with a grain of salt, but generally, blockages at the bottom of the heart generally aren't considered as dangerous as blockages higher up.  I've lived with two blockages that couldn't receive a stent at the base of the heart and was advised to take the meds, exercise, keep a heart healthy diet but expect a blockage that wouldn't be fatal, but I'd feel it.  That is exactly what happened in November, and I had a small MI, and I'm still standing.  Do you smoke?  If so, quit.  Exercise every day, and educate yourself about diet, take the drugs.  Best wishes, keep us informed.
976897 tn?1379171202
At the end of the day, it will all depend on your symptoms. If you have a bad quality of life due to discomforts and restrictions in daily activities, then they will put more emphasis on intervention. If you have hardly any discomforts and can perform your necessary daily routines without much trouble, then they will usually put you onto a medication intervention. One doesn't work for the other. If a patient can hardly breath and suffers lots of chest pains, medication will unlikely resolve the issue.
Surgery is the option when your quality of life is too low and this usually comes in two forms, angioplasty or bypass. In your case it has been decided that stenting is not an option and so a bypass will be the option offered, should the time come. The blockage you have to keep down is the 95% near the top of the LAD. This is a very common place for blockages. As others have said, life style changes are necessary including keeping your stress levels low. Hopefully, your blockage will not increase.
1209084 tn?1267371006
I honestly do not know if I can answer your question about what made my angioplasty so difficult, Flycaster305. To answer one of your questions, I have been virtually smoke-free since 2008 (I am down to two cigarettes a day, this from a two pack a day habit that lasted 35 years).  

The day after the procedure (presumably after I had come down from the meds), the surgeon told me that he stopped because he couldn't get the balloon through the blockages and he was afraid of tearing the arteries or knocking the blockages loose if he continued to press. He also mentioned that my intense shivering due to the cold was blurring the image on the TV monitor he was using, something that I continued to do even after I was wrapped in additional blankets.  But considering that I clearly remember watching blue koala bears with wasp-like faces climbing up and down the walls, clouds of steam issuing from the ceiling tiles, and Michelangelo-quality paintings and artwork on the entire ceiling during most of the procedure, I am not entirely sure that any recollection I could offer here could or should be trusted.  Especially considering that they took my eyeglasses away from me at the start and I am extremely nearsighted, I shouldn't have been seeing anything very clearly. But I certainly saw those creatures and steam and that magnificent artwork in clear detail. So unless they flew me to Rome and conducted my surgery in the Sistine Chapel, I would probably discount most of my recollections if I were you.

I do remember that I was told before they began that I was to be given morphine and Benadryl as an anesthetic.  I have had morphine administered to me before (car wreck back in the 80s) with no ill effects or hallucinations, so perhaps it was the Benadryl that knocked me for a loop. But I also certainly remember that whatever they gave me didn't make a dent in the intense pain I felt every time the surgeon moved that sheath and catheter.  It was like a sailor's marlinspike jabbed into my groin, and every move was like him twisting its blade.

I am pleased to hear that blockages in the lower part of the heart aren't considered as serious as others might be.  Perhaps with the passage of time and the small handful of meds I am taking, I can get by without attempting another angioplasty, something I really don't care to experience again.   I managed to walk for about 10 minutes the other day without my chest hurting too badly (only needed one nitroglycerin), so there is hope.
1209084 tn?1267371006
Thank you for your insight and comments.  These chest pains are certainly proving to be a quality-of-life issue for me, as my job used to require me to walk up to about 5 miles a day. I would be doing extremely well today to make it 100 yards without having to stop because of the intense pain and shortness of breath. The nitroglycerin I take helps, but only enough to get home. I am going to remain optimistic that I just fell into a freakishly bad set of circumstances during my angioplasty, and that it can be accomplished successfully at another venue.
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