Angioplasty and Stenting in the Elderly

• Sivaprasad -- success is a relative term. No treatment has been shown to prolong life. But angioplasty is used very successfully to treat angina, or to stop a heart attack which is in process. Your mother's heart attack is in the past, so the reason to do any intervention (angioplasty, surgery, etc.) would be to prevent future problems. Her breathing problems may or may not be related to any heart disease. Let us know what the angiogram shows.
Forum Editor, Angioplasty.Org, March 14, 2008

• My mother is 69 year old. She has been hospitalised due to serious suffocation (breath difficulty). The Doctor-in-charge told that the ECG showed the symptoms of a mild heart-attack. She was advised for angiogram. If necessary angioplasty may be done. Please inform me the success rate of the treatment of a 69 year old patient.
Sivaprasad T J, Civil Engineering, Thiruvananthapuram, Kerala, India, March 8, 2008

• A.D. -- we were just talking with a man who had angioplasty at your mother's age. He was in very poor shape, with an already weakened heart and had been refused for surgery. Dr. Howard Cohen of Lenox Hill Heart and Vascular Institute in NYC did an angioplasty on him, using a special cardiac support device called the Tandem Heart. The procedure was successful. He is now 92 and is conducting an evening of symphonic music next weekend -- three hours on his feet!
Forum Editor, Angioplasty.Org, October 13, 2007

• My mother who is 89 was just told she needed a stent put in one of her arteries. Would any of you go thru this at that age? Any insights on what I should tell her? Thank you.
A.D., California, USA, October 9, 2007

• Natalie -- we're sorry for your loss. Again, we don't offer medical advice, but whether or not angioplasty would have helped could only be determined by tests like an angiogram (invasive or even a CT angiogram) and/or stress tests. But these procedures are what is known as "revascularization" procedures -- bypass surgery also -- their purpose is to open up blocked arteries so the heart gets a sufficient blood supply (oxygen). But without evidence of blockages, the answer to your question can't be known -- however your dad had a number of other types of heart problems (CHF, valves, etc.) which angioplasty doesn't address. As for chelation, there still is no evidence that it does anything helpful. Diagnosing heart disease is very important -- it is our hope that that use of less invasive diagnostic tools, such as Multislice CT Angiograms, will make it easier for people to get the appropriate treatments they need.
Forum Editor, Angioplasty.Org, March 16, 2007

• My dad had chf (LV dilatation) 35%-45% ejection fraction, leaky mitral valve, hypertension (25 yrs 160/80-200/80) & Type 2 diabetes (20 yrs) He passed away Jan 15/07 just shy of 77 yrs. His meds were accupril, renidil, nitro-patch, bisoprolol, novo-propamide, lasix, warfarin. The last 3 yrs were pretty tough for dad. After pneumonia/septicemia chf kicked in. He was stable for 2 yrs, when a persantine stress test was ordered. We cancelled it because he was very weak & was having trouble walking. My question is would he have been an angioplasty candidate? Or would you have just recommended medication. He stopped the bisoprolol 5 months before he died because of a resting pulse under 40. He said he felt better off it. A statin was never recommended. He died quickly from an MI (CAD) and was comfortable and still independent @ the end. In his early 70's he took chelation therapy, we're wondering if that would have been the time for the statin and angiogram?
Natalie Lobay, Okanagan Medical Centre, Kelowna BC, Canada, March 13, 2007

• BA -- we don't make any recommendations -- that's something best done by your doctors. We can point to the June 2006 issue of the Journal of Invasive Cardiology, which published a major two-part review of the question, "Percutaneous Coronary Intervention in the Elderly Patient", written by Chicago-based Dr. Lloyd Klein. (Angioplasty is also called PCI.) The conclusion was that the decision to go in this direction depends on a number of things -- advanced age is definitely an independent risk factor for complications from the procedure, and age is not numeric, but physiological. Other health factors are important to consider, as well as the potential benefits, such as improved quality of life. It's definitely a balancing act. Here's an excerpt from the summary paragraph:

• My father who is 95 just had a thallium stress test which shows blockage around his heart. Because he is mentally so sharp and still enjoys life, his cardiologist recommended an angiogram and possible angioplasty with stents. He has a pacemaker for an irregular heartbeat, has had congestive heart failure (under control) and an aortal aneurysm (under watch by the doctor). He does tire easily, has some shortness of breath and is on several medications including norvasc, plavix and zocor. He has never had heart surgery. Would you recommend angioplasty in a man of this age?
BA, Florida, USA, February 22, 2007

• Christian -- it's impossible to diagnose a patient at a distance and the best advice is what your interventional cardiologist suggests -- after all, he/she is the one who will be doing the procedure. Also, we are not medical doctors, so while we could look at the angiogram, we can't give out medical advice. Angioplasty can be done successfully on elderly patients, but of course, your father may have other medical problems which could complicate the effort. Again, we support you asking as many questions as possible of the interventional cardiologist you are seeing. If you are determined to pursue a second opinion, I am thinking of Dr. "Gus" Pichard, a fellow countryman of yours, who is the head of the Washington (DC) Hospital Center cath lab. Here is a web page for him: http://www.whcenter.org/body.cfm?id=1485 Good luck and best regards.
Forum Editor, Angioplasty.Org, February 9, 2007

• Hi, my name is Christian, I need your help from Chile. My father Eliseo (age 87) is a heart patient, recently he was a coronary angiography or Angiography, and the diagnose was not good, I am very worried and desperate I want if you can help me seeing the archives of the Coronary catheterization, and give me one opinion, or a diagnostic for your disease...The Doctor Carlos Deck (Instituto del Torax Santiago de Chile) said that the only alternative is to open 2 of its arteries but that is very risky. The archives of the angiography are of 9 MB. please if someone is interested He can can send me the email to send the file. thank you very much I wait for this answer.
Christian Jara, Santiago Chile, January 24, 2007

• My mother in law had a angioplasty after 2 heart attacks when she was 89 years old. She was an active and vibrant women, so the doctors felt that her quality of life would be maintained. They were right!! She lived to be 103 and remained independent and in good health (while frail towards the end) until she died.
Susie, New York, USA, December 28, 2006

• Terry -- we are not physicians here and cannot therefore give you "medical advice". Your questions should be addressed to your mother's cardiologist -- but we recommend specifically asking him/her what the risks are and what the possible treatment options are BEFORE the angiogram. You might ask why a 64-slice CT angiogram isn't being done. This test is non-invasive and carries virtually no risk. Studies have shown a very high negative predictability -- that is, if it doesn't show a blockage, there isn't one there. Read the article on CT Angiograms in our special Diagnosis & Imaging section. If she does have a blockage, is it affecting her and will opening it actually benefit her quality of life. This cannot be diagnosed long-distance, but you should feel comfortable that what your mother's cardiologist is recommending is necessary or has a significant likelihood of improving her situation.
Forum Editor, Angioplasty.Org, December 26, 2006

• Please urgent advise needed. My mom age 90 may need angiogram and possible stent/angioplasty or surgery. she has a history of stroke in her family, has had high cholesterol problem and has a blocked (70-100%) left carotid artery. I am concerned about her having the angiogram. should I be? What about the stent? She had a recent mild heart attack and has shortness of breath and extreme fatigue. She lives independently and is fairly active and is in otherwise good health. Thank you for your response.
Terry Jaffoni, Plymouth, Minnesota, USA, December 25, 2006

• My grandmother has had 2 [angioplasties] in the last 2 months. She is currently in the hospital now diagnosed with a pseudoaneuysm in her right femoral artery. She was supposed to come home Thursday after the procedure and hasn't been getting any better. She has also had 2 heart attacks in the last 6 days. I will keep you updated on her condition. She is 86 yrs young.
Sharon, Omaha, Nebraska, USA, April 23, 2006

• Jay -- While we are not an "Ask The Doctor" service and do not and cannot give medical opinions, we try to do what we can, so we are responding to your urgent message. The general opinion is that bypass surgery, in fact surgery of any type, should be approached very cautiously in the elderly. Bypass surgery is a pretty big insult to the system and requires a level of recovery that may not be applicable in many patients. While angioplasty requires less recovery, and is often done in the elderly, each patient is different and ultimately a physician experienced in the success of outcomes and familiar with the specific patient has to make these kinds of calls. Medical management can be successful in patients for whom a higher level of intervention is too risky. And remember, none of these treatments are cures, only "fixes". But again, this type of opinion can only be given by a cardiologist who has examined your mother and who has her specific records. Perhaps you'd feel more comfortable if you got a second opinion from another doctor in your area -- if only to confirm that the decisions being made are correct. Look for an interventional cardiologist -- one who does angioplasty on a regular basis. Remember, all medical procedures carry risks and complication rates -- which is not to say they should not be done if indicated. Good luck, and we hope we have been of some small help.
Forum Editor, Angioplasty.Org, July 5, 2005

• My mother recently experience her 2nd mild heart attack in about 3 months. The doctor recommended against having angioplsty because of her age = she is 93. He said the risks of stroke at her age and condition is very high. She suffered a 5% damage to her front heart muscles. He recommends returning to her home with the same quality of life which she now enjoys rather than risk a stroke. He says that she is not a candidate for bypass surgery. She lives in a retirement community in Texas without assistance and enjoys good quality of life considering her age. She has good mental capacity, but is becoming quite frail and walks with assistance from a walker. I need an opinion quickly. She is in ICU tonight and I will be speaking to her in the morning. Can you respond quickly?
jay willhite, Hesperia, Ca, July 05, 2005

• My 89 year old mother had quadruple bypass in 1991...in 1993 two of the 4 grafts had to be replaced. At that time the surgeon informed us she would not be able to have any more done to her heart due to the fact she had no more good veins to use. She recently had a heart attack and had an angiogram. It showed another blocked artery. Is she a good candidate to have angioplasty?
Mary Jane Dahl, Minnesota, USA, 23 Feb 2004

• my mother was 61 years old. during angioplasty her doctor teared her vein and after bypass surgery and being 27 days in I.C.U she died she had the history of mastectomy of her two breasts, and after bypass she had problem of breathing. so i want to know was she a correct case for angioplasty? also i should to say that her plug was in sharp turn of vein.
vida abedi, chemistry and chemical engineering research center of iran, Tehran, Iran, 7 Oct 2003

• I only find questions. How do I find answers? Would like to know statistics for psuedoaneurym in groin artery after angioplasty. How dangerous is such a condition? Radiologist has tried to close it by injecting surgical glue and been twice unsuccessful. Wants to try again on my 88 year old husband, but after he returns from a 2 week vacation. How dangerous is such a wait? What are risks?
Muriel P., USA, 10 Sep 2003

• I am interested in information regarding angioplasty for a renal artery for a 75 year old woman who also has a mitral valve problem with her heart. Could you advise me on the risks of this procedure? My mother also tells me her doctor will put a stent in if the test shows the blockage he believes is there. Does this mean that she has renal disease or damage? Should she consult with a doctor for renal disease prior to having this procedure? Should an out of town daughter be present for this procedure in case complications occur? What type of complications could arise?
Cynthia R., Charlotte, North Carolina, USA, 10 Aug 2003

• Please send me information on the risks of catherization and angioplasty on an 87 year old mother with dementia and osteporosis. She is presently in a nursing home and is having bouts of congestive heart failure. I am concerned about her quality of life rather than quantity. She once expressed her desire not to have to linger in a nursing home.
Pat Trulove, teacher, Laurinburg, North Carolina, USA, 27 Apr 2003

• Again, I am asking the same question as to angioplasty and stenting in the elderly. My husband is 82, had 4 bypasses in 1984 after 2 MI's. The grafts are now 18 years old and he is experiencing SOB (shortness of breath). Otherwise is in good shape. Not diabetic. Can someone please give some info or direct me to info regarding safety for this age-population.
Anne, USA, 23 Feb 2003

• Please help. My Gran is 90 years old, good heart and good blood pressure. She has a blocked artery in her groin and the doctors are considering angioplasty. She has no pulse in her leg and is verging on gangrine. What are the risks. Please help. Many thanks
Carol, California, USA, 12 Jan 2003

• I have almost the same question: My mother-in-law is 88 years old. Her doctor is considering an angiogram which would probably lead to angioplasty. She is diabetic, has asthma, has been on a lot of steroids which have caused her skin and her arteries to be very thin. She is quite dizzy in the mornings. She is allergic to Nitroglycerin. I'm concerned that an angiogram might injure her arteries. Can anyone give advice?
Helga Mukhar, Sugar Land, Texas, U.S.A., 27 Oct 2001

• I too am interested in angioplasty for the elderly. My mother is 88, has had 2 heart attacks in the past two weeks, and has senile dementia. She's been in the hospital since the first hear attack and is on blood thinners. In relation to the elderly: What are the dangers? the odds for success? for failure? for repeat procedures? What is recuperation like?
Glenna, Boise, Idaho, USA, 23 Apr 2001

• My father is 93 years old, end stage renal, and diabetic. He experienced a second mini-stroke this week. After ultrasound, the dr. believes it was caused by a piece of catheter lodged in his left carotoid artery. He wants to perform angioplasty to retrieve the catheter, but also doesn't know if it is securely lodged into the artery wall. What risks does this pose for my father. Is it better to leave the catheter where it is, at his age. Please provide information and advice.
Sue Craven, Sound Transit, Seattle, Washington, USA, 13 Mar 2001

• My father's doctor has advised our family that our father may have a high percentage level of blockage in his artery and would like for us to consider the angioplasty procedure. My biggest concern is my father's age. He is eighty years old. Could you provide the percentage of successful procedures for his age group?
ROBIN DAVIS, LINDENWOLD, NEW JERSEY, 6 Mar 2001

• Would you recommend angioplasty for an 88-year-old woman who has congestive heart failure, only one kidney, and is experiencing the onset of senility? What are the benefits to the patient? What are the risks?
Dolores Nims, Carrollton, Texas, USA, December 18. 1999

• I am interested in information regarding coronary stenting in the very elderly (geriatric) population, re: increased complications, etc.
C. Belkin, MD, Brooklyn, New York, USA, March 8, 1998