Retrograde Angioplasty

[D0c]

I had been getting severe chest pains for some time and at the beginning of this year they started to travel to my left arm and lower jaw. The pain felt like pins and needles and then a crushing pain in the chest.

I went to my GP who sent me to the hopspital, I was given a test to see if I had a heart attack that came back negative but the ECG was bad, it showed I had inverted T waves.

Later I went for a Angiogram which showed 3 blockages one in my LAD which was 100% blocked, one in the right coronary artery which was 60% blocked  and one in the circumflex artery which was 70% blocked. I was put on 5 different pills and sent home to await a angioplasty.

In May this year I went to have my angioplasty, I discoverd I had 6 blockages, they managed to stent the Circumflex artery with two stents and the Right corronary artery with one stent. They attempted to drill out the LAD and managed to get through two blockages but failed on the third blockage, so the LAD is still 100% blocked. I was told I needed a Hybrid Coronary by pass and they would sort out a date.

I'm still getting alot of pain, and maybe an angina attack one every week. Always out of breath and cannot walk very far.

Today a letter came saying they want to attempt a RETROGRADE ANGIOPLASTY first before trying the Hybrid Coronary Bypass, but the choice is mine.

So my question to you is should I go for the retrograde angioplasty or should I just have a bypass as I'm getting really fed up now and just want to be better. I'm sick from work as well and I'm worried that I might loose my job and this brings the angina on more.

Thanks for listening, it's a weight of my chest.

Mick.

[kenkeith]

Your assessment is exactly what I was thinking, and I believe I would go the way of a hybrid bypass for the reasons you state.  Take care and good luck..    

[D0c]

Thanks everyone especially Ken for his very thorough answer. I'm seeing GP tomorrow to get some more pills and will ask his advice and later on will phone my consultant and ask him as well.

Personally I want the Hybrid Bypass as this is almost certain to be a success and I can get better quicker and return to work.

I have three full 100% blockages in my LAD, the guidewire went through the first two after quite a while trying to do it and when it reached the third blockage the wire could not be pushed through. I was on the operating table for four hours and it wasn't nice. My point of view is if they were unsucessful going through one way what makes the doctors think it will be easier and successful to go through the opposite way.

If I agree to the retrograde angioplasty and it is not successful, I then have to wait a further 12 weeks till I get my bypass, how do I explain this to work.

So confused

[kenkeith]

Thank you for your question.
I can give you some insight into retrograde angioplasty. The usual procedure is to use a guide wire through the occlusion, and apparently that procedure is not an option given the circumstance.  

As of a recent report retrograde angioplasty can be an option. For some insight: The retrograde approach for total occlusion (chronic) is a relatively new treatment strategy with its attendant complications having not yet been fully appreciated and described. An April 12, 2000 report.

The procedure (retrograde approach is gaining favor) is to go to the distal side of the occlusion and that frequently more amenable to guidewire passage than is the proximal side of the occlusion.  

There is some risk but when the chosen pathway to a given occlusion involves a retrograde approach via a septal perforator artery, its use provides some degree of safety.  So a consideration for you is how experienced the cardiologist in the new procedure?.  And what is his (her) success rate?.  

Hybrid bypass in a minimum invasive procedure that doesn't completely open the chest (faster recovery time. less bleeding, etc) and sometimes there is a robot engaged.  You may want to ask if there is a robot involved and if so how many successful operations.  Also, you may want to learn the surgeon's success rate and number of procedures?

Hope this helps and if you have any further questions please post.  It would be interesting to know more about the procedure and what you doctor has to say. Take care.

[ChatterAlly]

How much do you know about both procedures?  What does your head and heart tell you?  Have you discussed the differences with your doctor(s) yet?  Keep up posted.  Ally

[DiRose]

Highly suggest you talk to your doctor about the pros and cons of each surgery and I would also suggest getting a second opinion for such a surgery.