Dear Doctor,
In 2001, just before my 43rd birthday, I was diganosed with congenital stenosis of the left main coronary artery just beyond the bifurcation off the aorta. I had a 70 to 80% occlusion. At that time, my doctors recommended CABG over stenting. A double graft was performed, LIMA to LMCA and radial artery (harvested from my left arm) from LIMA to circumflex. I was pain free for about two years, then my symptoms returned. It was determined that scar tissue within the chest cavity had formed around the LIMA, above the radial to circumflex graft, that was "kinking" the LIMA and decreasing blood flow to both the LMCA and circumflex. A stent was inserted in an attempt to straighten the kink and improve perfusion. In the end, over the next few of years, the LIMA was stented several more times (I lost count) because scar tissue formed inside the LIMA at the stent site each time. My docs say I'm one of those few individuals with a propensity for scar formation. Finally, in January of 2006, the decision was made to stent the LMCA. By June 2006, this too had begun to occlude due to scar tissue, and a second stent was placed in the LMCA with a small portion of it extending into the aorta. At that time, my docs felt another bypass would be too risky because a) I was somewhat anemic, b) I did not want to be placed on a heart-lung bypass machine (my original CABG was done as a "beating heart" surgery), c) I do not want to receive blood transfusions, d) the new grafts would have to be anchored on the aorta itself, e) there is so much scar tissue in my chest now it would make the surgery much more complicated, and f) the risk of developing more scar tissue and ultimate failure of the grafts again is very high. Now, a little over a year since the last stent was implanted, I am having persistent cp again, radiating into my left arm, at rest or with the slightest exertion - my typical cp pattern. SL Ntg is somewhat helpful. Otherwise, my heart is very healthy. Repeated angiography and Adenosine stress tests have revealed no other narrowed vessels (other than the bypass grafts which have completed occluded) and no infarcted areas. I have no dysrhythmias, normal bp, normal cholesterol levels. My only cardiac meds are plavix and ASA. My doc would like me to take diltiazem or Norvasc for occasional bouts of vasospastic angina, but I have a poor tolerance of beta blockers and calcium channel blockers and the vasospastic episodes are rare and short-lived, so I have chosen not to use them.
Here are my questions:
1) I have heard a lot of negative discussion about self-eluting stents (which all of mine are) in recent months. Is there any relationship of the repeated scar tissue formation at the stent sites to the problems that seem to be coming to light with these stents?
2) I have no doubt, based on the return of my symptoms, that the latest stent is becoming occluded. Other than attempting another CABG what other options to I have?
3) What is my prognosis in this situation? I am under the impression that total restenosis, in my case, will be fatal. Obviously, loss of the LMCA will result in loss of the LAD which, as far as I know, is catastrophic. If so, how long do I have?
Thanks!