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5318543 tn?1366446439

How risky is 75 & 90% Occlusion in LAD Branches - Seeking deligent advice.

Hi Everybody, New to this forum and has read few posts to learn from the vets in the forum and decided to post this.
I had a MI on the 26th Dec. 2012.  Was able to drive to the ER and lay down fora Cath treatment which cleared a clot in one of the lower branches on the right side of heart, according to the Docs.  An Angiogram done at that time has
found two occlusions (75 & 90%  in the LAD and one on the right side, according to the Docs.  They are talking about quadraple bypass to begin with. Two mammeries and 2 using saphenous from my right leg. I am holding back hoping to postpone the bypass as long as I possibly can.  My LDL/HDL is 88/50 in Jan., 93/47 Feb., 79/48 March. I changed a lot of my bad eating habits and doing daily 30+ mts brisk walking , eating good fish, Almonds, legumes, fruits etc.
This is in hope of getting the HDL as high as possible to reduce any possible LDL build ups. I am on aspirin and ACE inhibitor now.  Have light angina time to time and when training little hard on the TMill. Any deligent opinions/ advice is solicited herewith, much thankfully in advance.
11 Responses
5318543 tn?1366446439
Diligent  NOT deligent - Sorry abt this mistake.
976897 tn?1379171202
I'm sure you will get different opinions from different people on this. Personally, I'm not a lover of bypass, but mainly due to my own experiences. My triple bypass lasted just 3 months, after being told it would last the rest of my natural life. I had the usual statistics presented to me, and was told that stenting would be too difficult. After it failed, I was in hospital for weeks with severe Angina, and met quite a number of patients who had also seen their bypass fail early, even after weeks. I was then transferred to another hospital where I met even more patients with the same problems. I was eventually discharged because the general opinion was "There is no intervention we can do, we will have to wait until you have heart failure and then put you on the transplant list. We have no idea how long this will take".
I was devastated and refused to give up, so I wrote to a research/training hospital in London where the real experts (professors) are. To my surprise I was called in for an appointment and met the Man who inserted the first stent in the UK, decades ago. He looked at my angiogram images, smiled and said "I can do this with no problem. I have to give you a risk assessment by law and I'm not allowed to say zero, so I will say 1% RISK". Expecting to wait several weeks or months, he then said "Go and get into a gown and I will do it now". I was shocked to see the other cardiologists who had said this was impossible suddenly turn up to watch the procedure. 5 stents later I was fixed. There is something else to consider with bypass, and it scared me after the procedure. The plaque is not covered and left as it is. This means it is still at high risk of rupture, releasing all the fats etc in the artery wall into the blood stream. A clot can then then form at that site. Of course if a clot forms there, then it won't do anything because it's bypassed, but the substance from the artery can end up anywhere, even in the brain.
63984 tn?1385441539
I'm sorry to hear of your heart problems, you have a lot to think about, and big decisions to make.

Your decision to adopt a very healthy diet will help you in the future, but if you have existing blockages, conventional medicine suggests that diet won't eliminate them.  Given your high risk factors, doing 30 mets to me suggests you are tempting fate.  I'd suggest reducing your exercise regime.

Also, where the existing blockages are located is very important to doctors as they advise bypass.  Blockages in the left side (LAD) can be very dangerous.  

I'd suggest you have the bypass surgery.  My blockages were addressed with multiple stents until my arteries were simply stuffed with them, I wish I'd done what was recommended early on and had bypass.  

5318543 tn?1366446439
Thank you for taking your time to respond.  Content well noted.  I am 59 now.  At what age did you faced with CAD, if I may ask. My problem is, it is hard for me to believe that I have a 90% occlusion and was running over 10Kms a hour, just few months ago, until, I had a knee injury. Anyways, Thanx again.
5318543 tn?1366446439
Thanx for taking your time to respond.  Content well noted.  May  I ask - My triple bypass lasted just 3 months, -  means, what happened.  This is a major factor, holding me back, going for a Bypass, as the Docs advise.  Also, I am
freaking out to see the scar left behind  in chest.(Sorry to say this, as you carry one at 52 - I am 59). Also, there is a school of thought about regressing plaque build ups naturally.  I am fascinated by the idea of increasing my DHL count and thereby reducing LDL build ups.  That is what I am trying right now.
Let me know, what you think, as, you are years ahead of me in this subject.  Best Rgds frm Japan.
976897 tn?1379171202
   Veins are not designed to do the same job as arteries, they can't withstand so much punishment, so when used in place of arteries there's a risk they can collapse. This is what happened to mine. If you think about it, the largest artery in the body comes off the top of the left ventricle (Aorta) and the coronary arteries are hanging straight off of this vessel. The heart is also moving all the time, slightly pushing and pulling on the coronary arteries. They go through a lot of punishment. The mammaries they refer to are the RIMA and LIMA vessels in the chest and these are actually arteries and can last a long time, even your natural life. However, as with your native arteries there is no guarantee these won't block too. It really is a terrible situation to be in, having to make choices.
One thing I should mention though. My left artery was blocked by an inch long lump of plaque, which they said probably started to form in my thirties. In reality I should have died when it blocked at the top, but like many of us, I opened some natural bypass vessels called collaterals. It looked very strange on the Angiogram because blood was flowing up the vessel instead of down. My left circumflex fed the artery at the bottom end, through vessels that opened when the pressure suddenly dropped on the front left side. There is a chance this can happen to anyone. The right side is normally pretty good at making such adaptations, but the left doesn't seem to kick into action with everyone, but it does with most. I personally found that controlling HDL/LDL a waste of time. My cholesterol was nearly off the scale due to hypercholesterolemia (hyperactive lipid production in the Liver). My cholesterol, thanks to meds, was made much lower than the national average, but I was still having at least one stent a year. I have 10 altogether. The one thing which made a difference is cutting right down on sugar intake. I haven't needed a stent for over 2 years now.
I have been thinking about your case and wonder if there's a third option you could enquire about. EECP. This is a regular treatment over a period of about three weeks, and then a top up may be required every couple of years. It involves having cuffs placed around your thighs which tighten each time your heart does its systolic stroke. This raises pressure in the upper body and forces collateral vessels to open up. The results have so far looked very promising. It kind of kicks nature into action if you like. I know that in the UK this option is only available if bypass or stenting is not an option but that's probably due to lack of resources more than anything.
With regards to the scar, It depends on the surgeons preference really. Some use staples and the scar ends up looking like a zipper. I had dissolving stitches and you really have to look carefully to see the scar. It's like a thin red line but I have a hairy chest anyway lol. I hope this information helps and obviously don't hesitate if you need more info.
Avatar universal
You guys are the ones I am going to ask for feedback if I get in a CAD situation.
5318543 tn?1366446439
Hey, Thanx again for taking time.  With regards to the scar, I met one Japanese guy (no hair - chest) who showed me the bypass scar.  I thought, he was butchered and I never want to look that way.  One major turn-off for a bypass choice.  I will  inquire about. EECP here.  Will keep you updated.<<<>> This is one point puzzling in my case, since, my Docs have no clear cut explanation of my supposedly 90 & 75% occlusions.   Would like to know how they determined it by one angiogram, which seem implausible to me.  This is an another turn-off for going forward with their advice. I am doing good amount of treadmill workouts on regular basis now and feel my endurance level improving with time.  Have you heard of the *Heart Clear*????  I feel like giving this a try.  I hope somebody on the forum may have some inputs with regard to this product.  Got to crash.  Bst Rgds to you all.
976897 tn?1379171202
So called remedies are ignored by me. With millions of heart disease sufferers, I'm sure the impact would be so great with any cure that it would be all over the media as fantastic news.
It's good that you are exercising regular, this can promote collateral vessel growth in the same way that EECP does. Those people who don't exercise seem to end up worse off. However, if you get angina symptoms, such as chest pains during the exercises, even if they are mild, slow down. When I had angina my limit was a heart rate of 140, anything above that and I had pains. The pains can signify that the cardiac muscle is being damaged, so in rehab first time around they gave me a threshold of 120. After my bypass I could get to 186 with no pains at all, but that was until the vessels collapsed. Now I can reach 180-190 with no problems.
The only factor you can go by is how you feel. A 90% blockage is risky because it can erupt at any time, spewing the mess in the artery wall into the vessel, blocking it further down. You then form a blood clot where the eruption took place, giving a double blockage. Millions of people are walking around not knowing if there is a time bomb in their arteries. It must be said though, not ALL blockages will erupt. The one at the top of my left artery didn't and it formed a solid lump of calcium an inch long in the end. This is what they had to get through with the catheter, to stent it. Slowly chipping away and catching the pieces to withdraw them.
5318543 tn?1366446439
Hi There, I am still here with nothing done by the docs, so far.  ((( not ALL blockages will erupt. The one at the top of my left artery didn't and it formed a solid lump of calcium an inch long in the end. This is what they had to get through with the catheter, to stent it. Slowly chipping away and catching the pieces to withdraw them.))) I am trying to find a qualified meds to do the same as you describe herein.  To see my 90% blockage is really a 90% and if so it is a hard or soft blockage.  Also if it can be treated without doing a bypass.
I am thinking of bio absorbable / degradable stent (TerumoCo., Abott Co.).
May I have your comment pls.   Thanx for same in advance.
976897 tn?1379171202
Well, I'm not sure about the benefits of a biodegradable stent? A metal one actually gets buried into the artery anyway as a new lining grows through the mesh. I need to do some research on this because I am a bit concerned about the use of them. Imagine you have a large amount of fat trapped in the artery wall which is bulging into the lumen, restricting blood flow. Along comes a metal stent and it squashes that bulge back into the artery wall and allows a new lining to grow. This stent will remain there for your lifetime, holding back the strain of the fat trying to bulge inwards. Now imagine a stent which dissolves. Surely, even with a new lining grown, that pressure in the artery wall will  eventually cause the lining to to bulge inwards again, restricting flow? There is nothing to hold it back.
If your blockage is 90% then your blockage is easier to deal with than mine was. My blockage was 100% and an inch long. Imagine trying to get a wire through hard calcium. With a 90% blockage this IS possible. They can actually deploy a safety net further down the LAD to catch any large debris that escapes and withdraw it safely. They can remove much of the blockage first if it is soft or hard, rather than simply using a balloon to squash it all into the artery wall. There are cutters, drills and all kinds of tools which can be used.
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