Stents vs. Bypass Surgery

[ItsMeDonna854]

My mom was taken to the ER yesterday.  It was determined she had a minor heart attack.  She had angioplasty and one artery (can't tell you which one) was 99% blocked.  All her other major ones were at least 50% blocked with some smaller ones being 90% blocked.  My mother was told by the cardiologist that she should go ahead and do bypass surgery, and not to wait too long, but she's deathly afraid of it.  She's feeling fine after having one stent put in and wants to know if you can just do all stents or would there be a reason not to do stents vs. bypass surgery?  An timely response would be appreciated!

Donna Olson

[ed34]

'Personally' I think it depends on the circumstances. IF you have just one blockage and you have sufficient collaterals, then yes I would try medication first, and if it keeps symptoms away, I would keep to that regime and make lifestyle changes. So, in such a scenario I agree.
I think your logic is sound with single vessel disease.

However, I do think it's in the patients best interest to have stenting or bypass if 2 of the three major vessels have heavy disease and just one major vessel is feeding all the collaterals to assist the blocked ones.

[nagrajjain]

What if patient do have blockages worth bypassing revealed by angiography but no chest pain and symptoms i.e primory reason for medical intervention. should he go for bypass? Inspite of advice for bypass I am living example for one year managing with medicines only. When I asked doctor if he gives guarantee of three months survival after bypass he refused. With only medicines I am surviveing for more than three months i.e. a full year. It is my individual case. All this is because I had two heart attacks. There is no guarantee by doctor of avoiding third heart attack after bypass and same is the case when manged by medicines only. i preferred by medicines only without expending very large amount required for bypass.

[ed34]

But again we are back to the 'what if' scenario. I assume if a patient has no symptoms, then there would not have been a visit to the cardiologist, because there would be nothing to trigger the appointment. So, to see a cardiologist, something must give a reason.
Let's say for example a patient called Fred has stable Angina, and with medication this seems to fine and he passes a stress test. Let's say that Fred opened up sufficient collaterals to feed his deficit areas and feels good when exercising. I believe a test, whether ct Angio or standard angiogram, should still be performed to understand the situation in this individual. What if the collaterals are being fed from one coronary artery which is the only one still open? say the RCA. Both his LCX and LAD are being bridged from this. Personally, whether he feels fine or not, I think intervention is necessary. If his RCA clots, he dies. If his other native major vessels are opened, then there is a much higher likelihood of survival. There would be two major vessels which could feed collaterals should one close down. This is why I think all patients should have some form of imaging when they have angina and not just be tested with pills and sent home if they work.

[nagrajjain]

In case of coronary artery blockages if there is no pain even after exercise then one should  manage with medicines only and should get second openion or even third openion before going for stents or bypass surgery. There are chances that colateral blood circulation may develop which needs sufficient time for body to naturally respond to the disease. In case of emergencies only one should go for stent or bypass not otherwise. Try to postpon stenting or bypass as as far as possible in consultation with doctor. It should be kept in mind that Stenting and Bypass are triggers for developing more blockages. Therfore there are many cases of complication and need for frequently doing again and again. God bless all to get proper doctor who can evaluate without consideration of finacial gain to him.

[kenkeith]

Q: "Well, the best way is an angiogram. This enables the cardiologist to get inside your coronary arteries and look around, exploring all the vessels." Not really the best way!"

"Please how can a blockage be detected even when other text says negative"  Blockage and/or potential blockage is better served by CT scan or MRI.  These procedures take images at different angles (slices) and then compile for a visual viewing.  Blockages and/artery remodeling (stenosis...narrowed channel) can be seen and detect any plaque in the channel (lumen) or if there is vulnerable plaque within and between vessel layers that can rupture into the lumen causing a heart attack.

CT or MIRA scan provide a full view of the vessel anatomy without the inherent risk of penitrating the vessel when poking around inside the vessel on an exploring expedition.

Thanks for your question and if you have any further questions or comments you are welcome to respond.  Take care,

Ken.

[ed34]

Well, the best way is an angiogram. This enables the cardiologist to get inside your coronary arteries and look around, exploring all the vessels.

[estellayem]

Please how can a blockage be detected even when other text says negative

[ed34]

It all depends on the severity of the disease. If there are just a few blockages that are
giving trouble and the disease isn't running all the way down the arteries, then stenting
will be prefered by the cardiologist. However, if there are lots of blockages and the disease is lining nearly all the arteries, bypass seems to be the best option.
I had an angiogram before my bypass surgery and the cardiologist said it would take a
bucket load of stents to resolve my problems. Even though I protested at this being just
a slight exaggeration, they would only offer me a bypass at the time.
When opting for a bypass, I suggest you insist they use the arteries from the chest
if they are in good enough condition rather than veins because they do last much longer.
Bypass surgery is actually very safe even though it's dealing with the heart. They have
so much equipment in there to deal with emergency situations, such as bypass machines. None of this exists in an angio suite. They have to rush you by trolley to the
nearest theatre if anything goes wrong, wasting valuable minutes.

[fwest]

Hi my name is frank  for 2 months  i had pain in my stomach that was burning and worked all the way up to my jaw  i finnually  called the doctor ekg  was bad sent me to er  got angograhm  lad was 90% and a another atery was 75 they wanted to do bypass i beg for stents they said it was like building a house with thumd tacks  they told me with in days if i did not get a bypass i could have a end of life heart attack because lad normally causes  death also  my heart attact  was a non ste heart attact i am on;y 48 years old  9 weeks still have pain  arterys when they did surgery calafied  how did this happen at such a young age and why not stents does the pain  go away commplety its been nine weeks is it becase they used the mammery artery

[ItsMeDonna854]

Thank you so much for your input!  Me being a CNA, my gut feeling was that he was telling her to go with byprass surgery for a reason, based on what he found during the angioplasty procedure.  Since I'm not there and don't know all the intimate details, its hard for me to do any viable research, but I did tell her I'd ask for her.  At least she can have peace knowing she made an informed decision.

[anacyde]

Hello Donna.  Sorry to hear about your mother's health and concerns.

Stents are typically favored as the first line of treatment when an artery is severely occluded.  However, there are cases when a stent is not a viable treatment option.  In my father's case, a stent was attempted, his artery was perforated and he needed an emergency bypass anyhow.  I would trust the doctors on this.  I understand her fears, but bypass surgeries are highly successful.

I wish her the very best with her treatment and health.