Total Chronic Occlusion of left circumflex artery

Question

A few weeks ago I had a stent for 75% occlusion in RCA. Found that the LCX was 100% blocked, collatoral veins were supplying area. Only 45 years old, have family history of CAD. Since the stent on the RCA, I feel great, no angina. Dr says I'm too young to have TCO, and wants to try to unblock it. I'm on the fence with this. Dr wants to try to unblock LCX with a wire and balloon, is it worth the risk? Thanks!!

kenkeith · Answer

QUOTE: "I dunno i am always tired too and just want to lay down all day. I get super out of breath if i just get out of bed to go to the bathroom. if anyone has any suggestions please let me know. thanks"

>>>>> There is a limited source for shortness of breath and two parts to breathing. The problem can be the moving of air in and out of the lungs.  The other part is moving oxygen and carbon dioxide back and forth between the bloodstream and the lungs.  
 
Blocking either of these functions can result in feeling short of breath. Anything that interferes with breathing leads to too little oxygen and too much carbon dioxide in the blood. Carbon dioxide  builds up pretty fast, and we need to get rid of it in a timely manner.  That which interferes with moving air in and out of the lungs would be a short list of asthma, COPD, collapsed lung (pneumothorax). 

Things that interfere with the transfer of oxygen and carbon dioxide between the lungs and the bloodstream are too little oxygen in the air and a blood clot in the lungs (pulmonary embolism).  You are not in a high altitude environment? Pulmonary embolism should be ruled out. 
With pneumonia ruled out that would leave a lower than normal cardiac output. DO any of you know if putting the stent in inflated back the left lower chamber of heart with blood and oxygen.  A stent wouldn't cause any back flow of blood from the lower chamber, but the back flow could cause a lower than normal cardiac output.  If that is the problem you should see your doctor as soon as possible to avoid congested heart failure.  That was my experience because the medical intervention was not timely.  Do you have a dry cough?  If you do, that would indicate an advanced condition and an emergency.

Let us know what the doctor says.  Take care.

kenkeith · Answer

Thanks for the update.  I can identify with renewed energy, and I know the feeling. I was in ICU for several days with heart failure and the RCA 98% blocked and stented.  Other occlusions were not treated, but I was not given any physical limitation instructions.  I felt so well that I immediately had the energy to mow two lawns on my two separate properties. I still feel well with the occluded vessels, but I don't have the same enthusiasm.  It definitely is a psychological boost as one doesn't really know for certain the outcome until it occurs. 

Good to hear the successes, and I wish you well going forward. Take care.

ed34 · Answer

Stents are great aren't they :)  It's not all bad news for everyone, we tend to forget all the success stories too quickly. Good luck, and keep your lifestyle healthy (wink).

Starfox9065 · Answer

Just another update, I ran 2 miles Sunday for the first time in years. It's as if my cardiologist put in a brand new heart. I went from exhausted and gasping for air after 1/2 a mile before the stents to feeling like I can run a marathon now. This was truly a miraculous outcome, more than I could ever imagine. My quality of life has increased tremendously, I sent my doctor a "Thank You" card for the great job he did.

ed34 · Answer

Have you been back to your cardiologist? If you are getting so out of breath, then something isn't right. There are numerous reasons why you could be getting short of breath but your first stop should be a cardiologist to investiage possible heart issues.

letmebegofindurself · Answer

I am 40 at 36 
had symptoms of heart attack with chest pain and went to hospital they did plenty of tests and nuclear imaging. well the imaging said that the lower left part of heart wasn't getting any oxygen or blood and they needed to find out why. I was seriously dizzy and in pain this whole time. After that they gave me angiogram and then found left circumflex about 95% blocked so they put a stent in. well that was a few years ago. I am still feeling dizziness these days. DO any of you know if putting the stent in inflated back the left lower chamber of heart with blood and oxygen. Well the reason I asked is I completely changed doctors when i had the nuclear imaging done. But had totally different doctor for stent. I was wondering if it was fixed. I dunno i am always tired too and just want to lay down all day. I get super out of breath if i just get out of bed to go to the bathroom. if anyone has any suggestions please let me know. thanks

kenkeith · Answer

As stated it is highly recommended, almost mandated if you will, to avoid all risks associated with CAD.  That will put your predisposition, if there is one, to a risk equal and possibly better than the general public.  Exercise is important as it will help decrease any stess if so inclined. 

What is your cholesterol measurement?  You stated in your first post there was no angina pectoris, and with the recent stent implant you don't have angina? 

 My cardiologist wants the cholesterol as low as possible without side effects, so with medication my numbers are about as good as can be expected (very good).  Has your doctor told you about the risks and expectations from Lipitor?

ed34 · Answer

Dont forget to avoid stress, it's a killer.  I know they talk about family history, but that can be simply due to the lifestyle changes they led. For example, if three generations were heavy smokers and consumers of fat, you don't smoke and eat healthily, you break the family history.

Starfox9065 · Answer

I celebrated over the weekend with some triple-decker Wendy's bacon cheeseburgers (just kidding!). I know how important it is to adhere to a lifestyle change. Family history is my major problem, I could stand to lose a few pounds because I quit running due to the angina I experienced. My blood pressure is normal, I can go off all of the meds other than Lipitor in about 6 months, and then it will be a baby asprin and Lipitor for the foreseeable future. This is a great resource, I greatly appreciate the advice and guidance you all have provided.

ed34 · Answer

great news and thank you for letting us know. I think your Cardiologist made the right choice for long term quality of life. You must now make serious lifestyle changes to prevent it happening again.

kenkeith · Answer

Great!! The response is welcomed, and I wish you well going forward.  Take care.

Starfox9065 · Answer

Just an update, I had the TCO in my ICX (circumflex) artery opened up last week. It was quite challenging for the cardiologist, it took about 90 minutes. There was a control room next to the cath lab where some other cardiologists were watching and they all cheered when he was able to get the guide wire through the lesion. They had to open a balloon near the lesion so the guide wire could make it through, then they ran the stent and balloon and it opened right up, it's flowing like a river now. They even gave me some great before and after pictures.

The length of the lesion was small, that probably helped in the successful outcome. Anyway, I FEEL GREAT! A very noticeable difference and no angina at all. I can feel a noticeable difference, so I'm so glad I listened to my cardiologist, who said I'm way too young to be walking around with a blocked artery. I noticed my energy level is much higher and I no longer feel so tired. I'm looking forward to running again!!

kenkeith · Answer

You are welcome.  To reduce the risk of blood clots, I take 167 mg aspirin that is coated to help prevent any unexpected excessive bleeding in the stomach .  Effien is also an anti-platelet medication for blood clots.  It seems there is excessive anti-platelet medication for protection against clots when weighed against the risk of excessive bleeding, but your doctor has your health records, etc. so there may be justification.

With angioplasty, there is a study that extra anti-platelet medication is warranted for the drug eluding stents (DES).  DES presents a slight risk for blood clots at the site of the stent implant up to about a year.  The usual regimen is dual therapy for protection that includes an aspirin and plavix or effien rather than plavix, and after a year stay with an aspirin.

Starfox9065 · Answer

Thanks for the feedback, I am on a beta blocker, 25 mg of Motroplol (sp?), 40 mg Lipitor, 10 mg Effien and 325 mg asprin. I'll take a look at that COURAGE study, thanks for the info! I will also report back if I go through with the LCX angioplasty.

kenkeith · Answer

For more than 6 years I have known there is a totally blocked mid LAD that provides sufficient blood flow with the collaterals, also, I had a 98% occluded RCA stented, and a 72% blocked ICX (no intervention) at the time of the dx.  I have been successfully treated with medication.  About 2 months after the RCA stent the interventional cardiologist wanted to do a stent on the ICX (circumflex).  I asked why that wasn't done at the time of the RCA stent (he doesn't speak English very well)?.  Didn't get a satisfactory answer.  I asked what a stent would do as I didn't have any symptoms?  No answer....a couple a weeks later he had moved to another state. My non-interventional cardiologist who has been treating me for the past approx. 6 years has never mentioned intervention for the ICX.

Ask your doctor what would be the benefit of an additional stent if you don't have any symptoms.  Since my experience 6 years ago, I have researched the subject, and the COURAGE study gives equal weight for longivity with the therapy available at the present time (medication, stent implant and CABG). 

There are quidlelines established by AHA and AAC that address the issue when to provide intervention and when to medicate.  Asymptomatic and lesion less than 70% ...no intervention...an estimate above 70% with symptoms, therapy should be medication for relief, if no relief then a stent implant, and if the location size of lesion, etc. prohibits stent(s) then CABG. 

You have a TCO and without doubt your cardiovascular system has blood perfusion to the area normally supplied with the TCO.  There is a possibility you will never require any intervention, but if you do the options will still be open...Also, medical advancement can in the future effectively treat by reversing some lesions. Keep in mind any therapy now available only treats the symptoms...stents can become blocked as well as a bypass and other risks as well. 

You can google COURAGE study and do other research as I have done for the past 6 years. Read and answered thousands of posts on the subject, and you may come to the conclusion to take a conservitive approach and no need for any intervention.  However, your doctor has your health and family history, etc.  But you have no symptoms, etc. so why fix something that is not broke as the saying goes.  Or if you will don't kick a sleeping tiger.

Thanks for sharing and if you have any followup questions you are welcome to post.  Hope this helps provide a perspective for you to come to the correct decision.  Take care.

,

ed34 · Answer

Your Cardiologist basically wants to do the same with your Circumflex as he did with your right coronary artery. I think he is looking for a long term benefit that will give you a greater quality of life and with life style changes, you should have a lot of healthy years to come. 
You have no angina but are you on medication such as beta blockers?