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Post CABG LIMA blockadge
My Father age 59, underwent By pass surgery (CABG) in March 09, in which 3 of his artries were grafted, all of which were more than 90% block, but after surgery he always complained about chest pain specially after walking few meters and breathlessness which use to ease out after walking more than 15 minutes, he feel completely at ease otherwise.
As adviced by docs here, we got CTScan done which showed blockadge in LIMA to LAD area, doc advised for angiograph, after angio we got to know from doc that LIMA is 100% block and hence could not expand it using bllooning technique.
Now doctors says that going for another by pass within a year would be risky and the only way out left is to reopen the earlier artery which was blocked (90%) by stenting and that artery would require 2 sents.
We are really worried and dont know what is the best way to deal with this situation.wether we should go by what doctors says or we should consult other doctors.
If we go for stenting, is it going to be completely safe, wether there are chances of again blockadge...lot of queries keep haunting us...we actually want to hera from some expert and get assured that it is curable and he will be fine again...
Thanks & Regards,
Seema
This discussion is related to Artery Blockages after CABG.
As adviced by docs here, we got CTScan done which showed blockadge in LIMA to LAD area, doc advised for angiograph, after angio we got to know from doc that LIMA is 100% block and hence could not expand it using bllooning technique.
Now doctors says that going for another by pass within a year would be risky and the only way out left is to reopen the earlier artery which was blocked (90%) by stenting and that artery would require 2 sents.
We are really worried and dont know what is the best way to deal with this situation.wether we should go by what doctors says or we should consult other doctors.
If we go for stenting, is it going to be completely safe, wether there are chances of again blockadge...lot of queries keep haunting us...we actually want to hera from some expert and get assured that it is curable and he will be fine again...
Thanks & Regards,
Seema
This discussion is related to Artery Blockages after CABG.
Basically living day to day with a 90% blockage to the LAD will cause different discomforts to different people and will certainly become noticeable upon any exertion, but different amounts again to different individuals. SOME people, not all, grow cross feeding vessels to try and compensate for the lack of flow through the blockage. In some people this still is not adequate for much exertion, but enough to maintain tissue life.
I am a bit surprised that the Lima has stenosed so quickly after surgery, I would inquire what the surgical notes say about the vessel. Before grafting, the Lima is checked for blood flow because it's obviously not worth grafting a diseased vessel to the heart.
Can they not stent the Lima? if not, is it because the blockage is too long?
A 100% blockage is not impossible to open up, it's just more tricky. Many 100% blockages are opened in leg arteries using lasers and rotablators, which are techniques also used in coronary arteries. The key is getting a catheter wire completely through the blockage to the other side, making a guide wire for such tools. It is rare for a Cardiologist to fail at getting a wire through even the hardest of blockages, there are many grades of catheter wire.
You have to think of many things when making a decision which is best. For example, it is risky to do nothing at all. Disease grew quickly in the Lima, rendering it useless. This could happen just as easily to the 90% blockage in the LAD, completely blocking it. If this happens and no new vessels have formed, then it's good night. So, it is safer and wiser to choose an intervention option rather than nothing. Yes, it could last many years without blocking, but every day there will be the worry of waking up the next morning.
A redo-bypass being too risky in less than a year? I have not heard of this statement before. However, it doesn't sound like you Father is an ideal candidate for bypass surgery to be successful anyway. I know someone who has received 4 attempts at redo-bypasses and they are still failing.
The Stenting option does seem the best solution but you can ensure a couple of long term factors here. Firstly, ensure they use Drug eluting stents. When you sign the consent form, you could write something above your signature such as "with the understanding that DES will be used, not bare metal stents". DES will not give the same
restenosis problems suffered by the Lima, the chemicals on the stents see to that.
Secondly, ask the Cardiologist how many of these procedures he has performed and how long he has been doing Angioplasty techniques. You really could do with a bit of experience behind the Cardiologist for this one. One slip with the catheter wire and the Artery can be pierced. There are many Cardiologists with plenty of experience in these types of procedures and you don't want your Father to be a practice dummy. Research or training hospitals/centres are usually a great place to find experience. I would also question the possibility of having the Circumflex stented because this is also a vessel which can give nasty angina symptoms when blocked so much. Your Father is only 59 and this is a good chance to get at least another 25-30 years added. So, think about finding the right cardiologist with the right experience, and state you want DES used.
Maybe your GP can find you a good hospital with the right experience. They are usually good at this with the contacts they make/keep through all their medical training.
Please keep us informed and I really do hope you have every success.
I am a bit surprised that the Lima has stenosed so quickly after surgery, I would inquire what the surgical notes say about the vessel. Before grafting, the Lima is checked for blood flow because it's obviously not worth grafting a diseased vessel to the heart.
Can they not stent the Lima? if not, is it because the blockage is too long?
A 100% blockage is not impossible to open up, it's just more tricky. Many 100% blockages are opened in leg arteries using lasers and rotablators, which are techniques also used in coronary arteries. The key is getting a catheter wire completely through the blockage to the other side, making a guide wire for such tools. It is rare for a Cardiologist to fail at getting a wire through even the hardest of blockages, there are many grades of catheter wire.
You have to think of many things when making a decision which is best. For example, it is risky to do nothing at all. Disease grew quickly in the Lima, rendering it useless. This could happen just as easily to the 90% blockage in the LAD, completely blocking it. If this happens and no new vessels have formed, then it's good night. So, it is safer and wiser to choose an intervention option rather than nothing. Yes, it could last many years without blocking, but every day there will be the worry of waking up the next morning.
A redo-bypass being too risky in less than a year? I have not heard of this statement before. However, it doesn't sound like you Father is an ideal candidate for bypass surgery to be successful anyway. I know someone who has received 4 attempts at redo-bypasses and they are still failing.
The Stenting option does seem the best solution but you can ensure a couple of long term factors here. Firstly, ensure they use Drug eluting stents. When you sign the consent form, you could write something above your signature such as "with the understanding that DES will be used, not bare metal stents". DES will not give the same
restenosis problems suffered by the Lima, the chemicals on the stents see to that.
Secondly, ask the Cardiologist how many of these procedures he has performed and how long he has been doing Angioplasty techniques. You really could do with a bit of experience behind the Cardiologist for this one. One slip with the catheter wire and the Artery can be pierced. There are many Cardiologists with plenty of experience in these types of procedures and you don't want your Father to be a practice dummy. Research or training hospitals/centres are usually a great place to find experience. I would also question the possibility of having the Circumflex stented because this is also a vessel which can give nasty angina symptoms when blocked so much. Your Father is only 59 and this is a good chance to get at least another 25-30 years added. So, think about finding the right cardiologist with the right experience, and state you want DES used.
Maybe your GP can find you a good hospital with the right experience. They are usually good at this with the contacts they make/keep through all their medical training.
Please keep us informed and I really do hope you have every success.
It is oftened wise to get another opinion especially when there may be options available. I have a 100% blocked LAD and blood flow has developed around the blockage feeding blood/oxygen to the deficit area and stent implant on the RCA 98% blocked and the circumflex is 72% blocked and medication does quite well for me going on 6 years.
It is difficult to generalize because there are many variables for or against some procedures for some people and not for others.
It is difficult to generalize because there are many variables for or against some procedures for some people and not for others.
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