are there alternatives to CABG

[eliezer]

II am 50 years old, thought I was healthy, played basketball, eat decently, not overweight but lately I was getting angina that seemed to be increasing. I went to a reputable cardiologist who recommended a cardiac catheterization. We did that last night and the results were: 3 vessels cad - prox lad 90%, ostial diag 90% (bifurcation lesion), distal racy 75%, 1st marg. 50-60%, 2nd marg 60%, distal RCA 75%. Recommend CABG soon.

Do you think there is a viable alternative that will really work and (preferably) before I croak!

[ed34]

Well, I see nothing to hide, it's hardly ministry of defence is it :)

The Cardiologist was Dr Rodney Foale. The location was London. The facility was Imperial College in Praed street, Paddington. It's actually joined on to St. Mary's hospital where I was in a ward overnight.

[ed34]

Well I'm in the UK, but if it's any use to you, I can certainly message the info. He not only works for the National health service, but also does private surgery in harley street london.

[yomill]

I know this is an old post, but I would like to have you share the DR. name and treatment facility location for your successfull procedure.

[ed34]

In September 2007 they virtually demanded that I have a double bypass which I kept arguing against saying its unlikely to work. The reason I was against the bypass is because of the level of disease all the way down my LAD. During surgery, they actually decided upon a triple bypass and sadly I turned out to be correct because the grafted vessels failed after three months. Just a few weeks ago I found a Cardiologist in a college/research centre who had 30 years experience in stenting. He was very confident about stenting because I suppose it was his main area of expertise. Every single Cardiologist at three major heart hospitals had all stated it was not possible to do the procedure. However, he removed the blockage, cleaned up and stented all the way down the LAD using a total of 5 long stents. It amased all the cardiologists, many of which actually witnessed the procedure.
The opening of the blockage and cleaning of the LAD opened up one of my bypass vessels, the Artery taken from the chest. So in effect, there is a built in bypass for the future.
I spoke to a professor also who stated the stenting was impossible. He said I was an ideal candidate for bypass surgery and the vessels would last the rest of my life. Strange how I couldn't get to see him after it all failed within three months.

[eliezer]

Ed thanks so much for your feedback. I wish i would have had it before yesterday when i went to see a professor, senior cardiologist. i did ask about the other options as i am not keen about going under the knife - he said - look i could open your blockages with angioplasty and stents but it would be the wrong treatment. you are young and the cabg has the best risk/benefit in your condition. he said i am not going to do a procedure at the expense of your health if the is a better alternative. like most doctors, he seemed very negative about alternative stuff, especially chelation which he said would kill me. my thinking was that if they could stent me and give me time, i could reduce the atheriosclerosos thru diet etc. and forgo the bypass. after his opinion though, especially about the danger of my current condition, it seems i have no choice but to schedule an operation within a week or so. I did not understand from your post - did they stent or did you have cabg? all the best to you and i hope you are enjoying good health now.

[ed34]

I think the key here is the prox lad occlusion of 90%. Although the term 'bifurcation lesion' has been used, different cardiologists use it to describe different circumstances. For example, some would use this term if your disease is close to the other branch, some would use it if the disease is affecting the other branch, causing a problem to both.
Imagine your main left artery begins from the aorta, if comes down the front, left side of the heart and is called the main stem. It then divides into two equal sized vessels, the circumflex and the left anterior descending. The 'fork' of the two vessels is the bifurcation and the report mentions disease there but doesnt describe how close it is to the fork.
If the blockage is not too close, then it could be stented. If the disease is over the fork then this would be very risky to stent because stents can be very difficult to accurately place in this area and can cause too much tension on the vessels. If all the disease  cannot be covered then re-stenosis is very likely. If I was in your situation, I would sit and look at the Angiogram images with the cardiologist, and look at how close the blockage is to the Y junction. If it is a few millimetres into the LAD and clear of the Y, I would ask why he feels stenting is not an option. I sat with several cardiologists looking at my angiograms and ended up having quite a steamy debate with some of them. My case was very similar to yours, my blockage of 100% was very close to the Y in the same area as yours. Only after having all other options did they finally agree stenting was the only solution. My CABG was I admit unfortunate, it only lasted 3 months. This is not the norm but some people dont seem to get on with bypasses. If they believe that stenting is a possibility and you choose that route, please please make sure you get someone with many years experience. My cardiologist had 30 years experience and is very highly regarded in many countries, but many only have a few years experience at doing simple tasks. When you look at your angiogram with the Cardiologist, each time you have a question simply say "what if" and describe your thoughts. You will be surprised how many love a think tank meeting.