when to stent

[jae1948]

I had a heart attack due to LAD blockage in 2005. A stent was put into place. I am on toprol xl, plavix, asprin. Last month Ihad another cardiac cath because of ongoing pains and failing my stress test. I was told I have an 80% blockage in the LAD just past the existing stent, 2 diagonals are jailed, and 70% stenosis in the RCA. I was given low dose nitro patch to wear 12 hours a day because my lower left wentrical is not receiving adquate blood supply and is ischemic. My doctor said the blockages are not warranting new stents yet. Anyone have experience and opinions on his method of handling this?

[ed34]

The usual standard is 70% or greater should be stented if there are symptoms in the patient, regardless of medication. It isn't just the size of the blockage, there is a risk of serious problems if that 80% blockage ruptures into the artery. Think how much soft plaque there is under that calcified plaque, filling across 80% of your artery and you don't want that let loose into your blood stream. I am wondering when your Doctor considers a blockage is large enough for intervention, perhaps he is waiting for you to have a 100% blockage and a heart attack. You obviously have a blockage, the blockage is obviously growing and is now 80 %. The rate of growth is unknown, all we know is that it wasn't there 7 years ago. It could have started last year or the year before, nobody has the visual history to tell.
I would go for a second opinion. I would also be asking about the 70% in the RCA.

[anacyde]

It sounds like you have a lot going on there, and I would want a second opinion.  I'm no expert, but it seems like there is just too much to not intervene somehow.  Sometimes another doctor can offer a different treatment perspective.  Good luck to you.