How to live with 100 PerCent Blocked LAD

[revcforde]

My husband has been seeing a well known preventive cardiologist in Houston for two years after being diagnosed with severe CAD and 100 Per cent blockage of the LAD and one other artery.  He has been a marathoner, played full court basket ball until he was 55 (ten years ago).  After his younger brother died from a heart attack at age 48 and his dad at age 62 plus discovery that his stamina was really decreasing... he had a calcium tomography showing he was in the 95th percentile of having a cardiac event in five years.  Five years later he repeated the CT scan and his numbers doubled.  At that point he had a PET scan showing the severe CAD in all of his arteries.  the cardiologist wanted him to do an angiogram; but he refused because of familial issues with invasive procedures and chose to begin the two year program to reverse CAD. the cardiologist suspected his CAD was genetic looking at the PET scan vs  his athletic fitness, perfect cholesterol panel, etc.  He was diagnosed iwth LPa ... a genetic component to CAD with a score of 130.  Normal is 30.  He has been on Lipitor, Plavix, and 200 mg of Niaspan plus following the severely restricted fat (15 gm day) 100 per cent of the time for the past two years.   His appointment this past week for the repeat PET scan two years later showed NO change.  100 per cent blockage of the LAD and 100 per cent blockage of another artery 9lower down).  He is not a candidate for bypass surgery.  He is asymtomatic with plans to cut back fat even more drastically.  Obvioiusly he has collateral circulation but that is not enough under heavy stress.  My questions are ... will this unblock the blockages?  Is there any medication that will clean the arteries?  What happens to the heart with such inadequate flow:

[ChatterAlly]

I have to ask this.....what are his cholesterol numbers?  My brothers and I inherited our father's "Familial hypercholestrolemia"  (I think that's it) My trigs were over 2100  2 years ago. I take a fenofibrate and a statin that have helped lower my numbers dramatically. I am still unsure about the use of statins and fenofibrate, but I have stented arteries (iliac) in my stomach to my legs, 3 in my heart and now have lost vision in one eye because of plaque in a small vessel to my retina.  I have to consider these consequences when making a decision about taking the drugs or not. Which one out weighs the other.  Take care, Ally

[ed34]

Hi, you are always welcome. In fact, I think your Husband has been wise to avoid intervention so far, because in many cases it can make you feel worse. Perhaps if I explain my history briefly, you can learn many things from it. What I experienced is far from uncommon.
In Jan 2007 I was training 5 days a week in martial arts and working 7 days a week in the construction industry, very labour intensive. In Feb 2007 I got what I thought were severe stomach cramps after eating an evening meal. I sweated heavily for about 15-20 mins and it went away. The following day, the same thing happened. On the third day I went as white as a sheet so went to the hospital where it was discovered I was having MI. I was rushed for angioplasty in London where my left circumflex was discovered to be clotted. It was also noted how my LAD was blocked at the top with solid calcified plaque and my RCA was totally blocked half way down. These blockages had existed for years without me knowing. Now, you would assume (logically) that now my circumflex was open again, that I should be as fit as I was before. After all, my arteries were now the same as they were a week before. WRONG, I felt like I was 90 years old at the age of 46. I now know what happened. I had very good collateral feeds from my left circumflex feeding the LAD. My RCA had its own collaterals, going straight around the blockage. When I ate something, the extra demand on the heart was too much for digestion, the blocking left circumflex didn't have enough flow to supply all the collaterals, giving me Ischemia. When the stent was inserted into the Left circumflex, the much larger flow seemed to alter the way my collaterals were configured. It appears that the same collaterals don't always open, you can have many configurations each time they open. The rear/left of my left ventricle was getting a great supply now, but the front, left was poor. I was then told I would benefit greatly from a triple bypass, and this would last me the rest of my life. I of course agreed (stupid me). They grafted an artery from my chest to the LAD (Lima) and took 2 veins from my leg, one for the bottom of the LAD and one for a diagonal vessel. After 3 months, I was suddenly on my knees for 5 mins gasping for air. Then I seemed to recover. The two veins collapsed, and some collaterals opened up. Angina was now back again with any exertion. I went to three top heart hospitals to speak to the experts, gathering possible options. Most said I should go on a transplant list. A top surgeon in the UK said he would be willing to remove the inner layer of the LAD, but I decided against it. Then a Cardiologist in Imperial College London heard of my case and said he would re-open my LAD and stent it. He was so confident too giving a 1% chance of problems during the procedure. He managed to get through the blockage with the catheter but pierced the artery wall, which he stented quickly because it was leaking. He stented the whole vessel, which took 5 of the longest stents. In recovery I did have a strange episode where my heart suddenly went to over 200 bpm, and they knocked me out. I woke up 6 hours later feeling like new. I then had a lot of stress at home and developed a new blockage in the left circumflex, requiring 2 more stents. At the end of last year, I received a letter saying I need more intervention because the left circumflex looked like it had a low flow rate. During the procedure nothing could be seen but they used a flow sensor on the catheter which gives a constant read out of blood flow and pressure at the tip of the catheter. Microscopic irregularities in the artery wall were causing blood flow to slow down, not visible to the eye. 2 stents fixed this and I have felt great again since. So, what have I learned in all my journey?  Have the right tests. A nuclear perfusion scan is important because it shows where good levels of oxygen are being received around the heart, something you cannot see in an angiogram. This gives a good clue which vessels require attention and where good collateral feels are present. Most collateral vessels do not show up in an angiogram because they are much too small, like hairs. During any angiogram, insist they use FFR, to know what blood flow is really like in any vessel. This is the sensor on the tip of the catheter, but very rarely used. A vessel may look narrow but could have good flow. It isn''t always the big blockages which cause issues, small ones can be worse.
The most common medication to dilate arteries is GTN spray. However, I avoided this because it gives a sudden drop off in blood pressure, giving nasty headaches. If there are no symptoms when sitting down, or standing still, this is the best way to recover.I used to do my chores then if angina appeared, I would stand still for 2 mins, then carry on.

[revcforde]

I erred.  The distal branch of the right coronary artery also called the posterior descending artery is the name of the other 100 per cent blocked site.  

[revcforde]

what is the medication to dilate and prevent further damage?  Thank you for being so kind to reply!  I do so appreciate your message.

[revcforde]

Thanks for such good news.  My husband's LAD and the Posterior Right Descending artery are both 100 per cent blocked.  We were told there are two doctors in the US who have the equipment to unblock or attempt to unblock this kind of blockage.  I am encouraged by your report/reply.  Last summer we hiked and he also did trail maintenance like bending/lifting/cutting down heavy branches but has never had a twinge of discomfort or any other symptom.  Fortunately he has been an athlete all of his life and his heart rate is excellent (resting is 51).  He notices a lack of stamina.  He takes 2000 mg of Niaspan, 20 mg of Lipitor, and Plavix plus a whole host of vitamins - no more then ten fat grams a day, no beef just fish or chix or turkey.  The most important thing I am hearing from you is that you have survived living with the blockage to the point that the doctors felt compelled to do bypass surgery and you survived that!  The most challenging thing I face is that my husband has steadfastly refused to do anything invasive because his brother died at age 48, his dad at age 62 and his mom mid-seventies from unsuccessful by-pass surgeries.  Two years ago after the first PET scan the dr called us en route to the office for labs to let us know he was lining up surgery(angiogram) but my spouse refused anything invasive despite the doctors persuasiveness.  At least now,  two years later, with nothing changed in the blockages, he is pondering the IDEA of an angiogram at some point. Soooo with two such blockages (100%) of major arteries... he must have a lot of corollary blood flow?    

[ed34]

Hi
    Unfortunately there is no way to reverse the disease, yet. Yes it is obvious that collateral development has occurred because, and I'm being honest here, he wouldn't still be here. If there are no symptoms until heavy stress, then the collaterals are doing a pretty good job. Now, what can be done. Well, that all depends on the skill level of the cardiologists you are seeing. Personally, if this was my heart then I would do this in 2 stages. First of all, I would make an appointment with the cardiologist and sit with him, looking at the angiogram images of the arteries. It is important to establish which vessel is supplying these vessels and get it as clean as possible. There are 3 main vessels, the right/ left coronary arteries and the circumflex. If 2 are blocked and the one supplying the collaterals is starting to block, then big trouble lies ahead. Once you establish the vessel feeding the collaterals, I would have any disease treated with stents to make sure it's fully open. This will then give plenty of time to look at options with the remaining blockages. There are a handful of hospitals which take on very difficult cases with stenting, but finding them is a task. Nearly all cardiologists quiver in their boots when it comes to stenting high levels of disease. It took me 2 years to find someone to re-open  my LAD and it took 5 long stents. I found the best solution was to approach a training/research hospital because this is where all the experts and best equipment are. The man who did my LAD was the person who installed the very first stent in the UK and was the first to use a balloon here. Around 30 cardiologists from different hospitals came to watch the procedure, all the ones who said the task was impossible. My arteries are finally fully open and it has been a long journey.