How many Stents

[heartmomma]

I have a 51 year old spouse who had a heart attack on the right side of the heart.
On the left descending wall he was 99% blocked in one artery and blockages at 82% etc.
He now has 9 stents total. How many stents can be placed and would open heart surgery
be better. We live in small town and have a Catholic Hospital here that has a Cardiac Program.
Would open heart be better?

[Flycaster305]

I have eight stents, and the question you asked is forever on my mind.  Yesterday I had a angioplasty to determine why I was having symptoms of chest pressure and breathlessness upon exertion and I had a stress test indicating  blockages.  Once again I avoided bypass with just clearing out the existing stents, and learning that chest pressure is probably due in part to small vessel disease.  
I have read the COURAGE study very carefully but one big question in my mind remains: in an emergency situation where heart attacks are happening, how many lives have been saved by bypass and stents.  I'm guessing the number is substantial and I doubt many lives are saved by medications at the moment when immediate intervention is required.

Before my angiogram I asked my doctor directly the question you asked, and he replied that because I have lost a good deal of weight, have excellent cholesterol control and watch what I eat and exercise daily, he would hope that stents could be used for blockages as long as practical as more interventional surgery (bypass) could weaken me physically.  Angiograms and stents for me are a walk in the park.

I've not answered your question as I, like Kenkeith mentioned, believe no clear answer is there for everyone, every case probably needs to be considered on its own merit.  I would tend to opt for stents as long as possible as they are less invasive.

Best wishes.  Keep us informed.

[kenkeith]

I don't know the limit on stents, but there is a limit on how many bypass surgeries as there is a limited source for harvesting vessels.

I have 100% blocked left artery descending, that has developed collateral vessels that provides blood supply to the deficit area.  Some occlusion in other vessels, and nitrates gives relief to any angina (chest pain) prior to workout at the gym.

If medication gives relief to any discomfort and there are no other issues, then an intervention may not be necessary.  If an intervention is necessary, your doctor/surgeon would be in the best position to answer which is better.

I say if there is no pain, etc. interventional procedures do not increase longevity.  The COURAGE study after double blind tests that continued for a number of years and the results were there is no difference in longevity among medication, stents, and by-pass.