Angioplasty.Org Home




Editor's Blog



Imaging and Diagnosis of Coronary Artery Disease












Donate Now to Angioplasty.Org

    

Angioplasty, Bypass or Medication?

Is there a time to stop with recurring angioplasties and go with bypass surgery? When should bypass surgery be done instead of angioplasties?

Add a Post to This Topic          Return to all Forum Topics

Current Postings on This Page (19):

• D.S. -- an "ad hoc" angioplasty is one where the diagnostic catheterization procedure is converted into an intervention (stent or angioplasty) and everything occurs in the same session. This is done when the problem is clear, obvious and is easily fixed in one session. In your case, there was a doctor/patient judgement required. We'llalso bet that you had been given a sedative to relax for the procedure -- something that would it difficult for you to make a decision. Even if you hadn't been sedated, it is hard for a patient to make such a decision on the cath table. A decision about bypass vs. angioplasty for multivessel disease is a complicated one and should be made in a rational way with all the facts in hand, and not in the midst of a procedure. We would encourage you to consult a cardiac surgeon (a doctor who does bypass surgery) as well as other interventional cardiologists (these are not surgeons -- they are the doctors who use catheters to do angioplasty). Stents are definitely used for multiple artery blockages -- but in some cases of diffuse disease, bypass may be the better option.
Forum Editor, Angioplasty.Org, April 30, 2008

• Can anyone help me? I have been diagnosed with 9 blockages in all three main arteries. During angiogram I was asked to decide if I wanted bypass or stents. The surgeons said they could do one stent then and four later. Others would not be able to be fixed unless I did bypass. I am a 53 year old woman and was not ready to make decision. So they did one stent. Now after review I have decided I would rather have bypass. I am having chest pains, pain in back and arm. My cardiologist says I can not do bypass now as I am on plavix and must stay on. It is a drug eluting stent. Is this so? They want to do more stents and I just am not sure I am comfortable with that. Thanks.
D.S., Wisconsin, USA, April 18, 2008

• Dilip -- no "opinion" from the internet, this site included, should be a substitute for medical advice from a medical doctor. As for stents -- FDA approval means that the device has gone through rigorous trials and presentation of data here in the U.S. There are many devices outside the U.S. that never get FDA approval because they never apply for it -- mainly these devices will not be sold in the U.S. anyway. Whether one stent is "better" than another is something you might discuss with your cardiologist. Some stents are better for certain patients or situations, some for others. Your quick description indicates diffuse disease and multiple blockages along with diabetes -- these are all risk factors for restenosis with stents and most cardiologists would strongly consider bypass surgery in such cases, but again -- these are discussions best conducted with your cardiologist so you can intelligently discuss the pros and cons
Forum Editor, Angioplasty.Org, March 17, 2008

• I had a bit of mid-chest pain one day during morning walk, this pain subsided after a few minutes and I could re-walk . This happened for a few days , EGC was normal, I started taking beta blockers, and found that I could walk better, without much discomfort. But I did treadmill test (TMT) showing ST depression about 4.5 mm exercise time about 6.5 minutes .ANGIOGRAPHY showed lad diffusely effected from ostium onwards tightest part showing 90% block, LCX 90% block, RCA diseased, non-dominant. Diabetic, on oral drugs. smoked 15 yrs ago. Will stents do? or do I need A BYPASS? ARE FDA APPROVED STENTS BETTER THAN NON FDA APPROVED STENTS? PLEASE ADVISE.
Dilip, Chittagong, Bangladesh, March 15, 2008

• i am having a problem of deciding whether to go for bypass surgery or angioplasty.. the angiogram was studied by 3 different cardiologists who came to three different conclusions. a) the first doctor advised to go for angioplasty. b) the second doctor said that this is a certain case for bypass. c) the third said that the blockages can be cured by medicine. As a layman what should one do to take the right decision and how to know that the decision will be correct. can anybody help me...
Venkatram Srinivasan, Kolkata, India, February 22, 2008

• Dr. R. -- not clear on your timeline as to when you first had stents. But your question is one that is central to all the research being done on coronary artery disease (CAD). As we've said, angioplasty, stents, even bypass surgery, are not cures for CAD -- they are mechanical solutions to biological problems. However, they do have the ability to "turn the clock back" somewhat in terms of putting off an acute event, perhaps completely. You're certainly doing all the right things vis-a-vis diet and lifestyle. Every week more is being learned about genetic markers, etc. and the hope is that the mechanism that causes these blockages will be discovered and therapies invented. Meanwhile monitoring and, assuming it's possible, stress reduction is very important (an important part of Dean Ornish's therapy is meditation).
Forum Editor, Angioplasty.Org, February 14, 2008

• To keep this topic open and ask the editors for help, please. I had 2 DES in Dec. 07; 1 each in the RCA and circumflex. After one year I stopped the plavix for 5 days and seemed to have a recurrence of the anginal symptoms experienced before the stents. I restarted the plavix but after 5 days of continuing symptoms, called my cardiologist. Next day recathed. The stents were wide open BUT 2 new 90+ % blockages in the same arteries (and a 60+ % blockage in the LAD); ALL NEW! 2 more DES in the RCA and Circumflex Any thoughts on what has caused the rapid progression of my disease? I have NO co-morbidity , had no MI before the stents, have exercised regularly for pretty much my entire life (was a fat kid until age 16), was eating a pretty darn good Mediterranean type diet (Italian American wife who is a great and aware cook), have had acceptable cholesterol levels. I visited a preventive cardiologist and started Zocor in hopes of dropping my 95 LDL level below 60 in an attempt to reverse the plaques. I am now on a Dean Ornish-ish diet as well. Any suggestions on what I might do to stop this before I do have an MI (and perhaps die from such)? What is going on? I am scared. Thank you for any insight anyone may have!
Dr. R., Pennsylvania, USA, February 14, 2008

• I had a des in 2/05,and put on various heart meds.In 4/07 I had a thallium stress test showing positive! Waited until 11-07 for a heart cath. Dr.said I needed a triple by-pass immediatly.Well now it is 12-28-07, no by-pass done and still alive! I have been thru three cardiologists over the last year due to not listening to my concerns about drug reactions,etc. (like them knowing everything and you being ignorant.) I have done so much research on the internet about the heart and I feel betrayed by the medical community for all the trust I have placed upon the guys in the white coats. For the most part they either lie to you, ignore your complaints, like my severe joint/muscle pains or are arrogant and belittling to you. I wish I could leave this planet at times out of medical frustration. I had asked my last cardiologist the cost of a cath he wanted performed and he said approximately $7,000 to $9,000 dollars.Well my bill came in for 18,800 dollars.They don't have a clue about the cost of these procedures they order today.The surgeon talking to me in the cath recovery room saying it was imperative that the triple by-pass be done immediately. He was asked by me of the "COST" of the procedure.You will laugh at his response! $50,000.00. Most of us have heard of the cost ranging from 100,000.00 and up, surely higher with complications (major surgery you know). So at home I stay,(alive anyway) far away from these crack pots and their evasive, expensive, and experimental procedures, hoping for death to rescue me from this life's medical madness. Happy New Year every one!
G., Canton, Georgia, USA, December 27, 2007

• my dad had no symptoms before a stress test was performed. was told he had 98% blockage and was a heart attack waiting. he had angio w/5 drug eluting stents and did well. the dr. could not complete all the clogs because of two much trauma for the body. three weeks later he had two more stents put in and never really felt well. one month later rushed to er in pain, some sort of scar tissues needed to be cleaned out. continues to have pain, fluttering, and problems walking more than 10 min. dr. says he is fine. changes drs for second opinion and has an another stress test and does "terrible", "everything is all over the place" new dr. says probably cannot get any more stents will most likely need open heart surgery. My dad never had a symptom before it had the first stress test. is open heart surgery still done and what would make his problem so severe.
nancy rodriguez, New Jersey, USA, June 29, 2006

• In July, 05, I had quadruple CABG, 3-SVG's and 1-LIMA. 2 months later (9/05), mild MI. Angiogram found that all 3 of my SVG's were scarring internally - 95%, 98%, and 100%. 2 Cypher stents in the SVG to LCA, one in the SVG to RCA, SVG to circumflex "lost". Within 2 months, I was experiencing chest pain again, took a nuclear stress test January, 06 - "passed", pressed the issue (pain was getting worse), angiogram in March, 06 found 95% blockage inside the 1st stent, SVG to LCA. Cleared scar tissue and put in another stent inside the existing one. Pain continued worsening, In June, 06, another angiogram, 85% blockage inside the stent SVG to RCA. After that one, I am STILL having discomfort. Bypass surgery, then 3 stenting procedures in 9 months - I'm on Plavix, Zocor, aspirin, Altace, metroprolol, and supplements - cholesterol down to 129, and I exercise every day...2 cardiologists, both of which I like and think are capable, but they don't seem to be able to suggest alternatives to just repeating the past.
Bruce Parker, Rosenberg, Texas, USA, June 22, 2006

• Response to Gary NcCleary, Roseburg Oregon: "To me sounds like better to be opened up and have the grafts performed and be done with it? Or does restenosis occur as often in bypass?" Regarding restenosis in bypass surgeries: Some do and some don't. But, aside from that, you have a higher risk of death during or soon after bypass surgery i.e., 1-3%. And, in addition to that, you have a higher incidence of side effects, and while 60% have no problems recovering from the procedure, some 40 % of the patients do, especially witth cognitive dysfunction which can occur in this unfortunate but still substantial miniority of the cases. Most of that is dismissed rather cavelierly, since the majority of patients are back to normal in 3- 12 months but during that period the patient may be handicapped by confusion, memory problems and, in general, a slight loss of intellect i.e., as in 5-10 IQ points. Most importantly though, is the fact that for a significant percentage of this sub-group patients, their cognitive dysfunction is more profound and for this smaller group, they may never be themselves again. Some go straight to nursing homes for the rest of their lives. Don't take my word for it. Just check out Bypass Heart Surgery and cognitive dysfunction on Google. Look for the studies done at Duke University! I noticed you didn't mention the feasibility of opting for any other treatment options and that is probably because you may not be aware of any other treatment options. There is a VERY SAFE, FDA approved NON- INVASIVE treatment that is covered by CMS and most insurance companies for Class III and IV angina. Besides reducing the pain and shortness of breath of angina, It also improves the functioning of the vascular system which can dramatically reduce the incidence of restenosis and actually increase collateral circulation to the heart itself. And, it generally costs less that the sales tax on a bypass surgery. It is most commonly referred to as Enhanced External Counterpulsation (EECP) and is generically referred to as ECP. See www.eecp.com and if it sounds reasonable to you, just ask your doctor nicely if he will let you try it. Chances are good, if you really want the treatment, he will cheerfully oblige you.
Gerald Oros, , Collinsville, May 5, 2006

• "Joe, Retired Amy, Jax, Florida, USA, 9 May 2001" . . . I just read your posting. . .Have you had the Anthrax Vaccine?? Anyone know this person or his Email address? PLEASE have him contact me immediately at AVAVICTIM@YAHOO.COM We seem to share the same exact course in getting stents. I also have 15 Stents installed with 7 angioplasties over a 28 month period. RCA and LAD . . . No MI YET!
RayZ, San Diego CA, December 7, 2005

• Dear barbara john and joe I know a case in our family circles. To the person instent-restonsis occurred within three years after insertion of one stent. Second stent was suggested butHe refused. He stopped taking medicines He started taking vitamin c and Linus'Pauling's Heart technology one jar a month. He is able to work. He said all pains, sleepy feeling, etc., gone. It is a high dose of vitamin c, between 3000 mg to to 9000 mg or more and few other ingredients. FDA suggests upto 90 mg or so only. If you are interested You can try. It cosats about $50 per month. You may give a try. I am in no way connected with this product
Venkata, California, USA, November 12, 2005

• I HAD ANGIOPLASTY ABOUT 8 YEARS AGO. THEY SAY EVERYTHING IS OKAY BUT AFTER DOING A LOT OF READING & WONDERING WHY I AM EXTREMELY TIRED AND HAVE MUSCLE ACHES I CAME ACROSS AN ARTICLE THAT SAID THAT WHEN YOU ARE ON ZOCOR YOU SHOULD BE TAKING CQ10 - (GEL TAB) HAS ANYONE HAD ANY LUCK WITH THIS OVER THE COUNTER VITAMIN
MARGE, CHICAGO, IL., 22 Apr 2003

• Dear Barbara and John, I am 46 yr old male, retired army, and had 3 MI's in the past year, and 5 angioplasty's mostly in my RCA, every 2-3 months I get a 95 to 99% blockage in the RCA, and now the LAD, I have stents on top of stents in the RCA (i believe 12 in all have been inserted in the RCA, and 3 in the LAD. My most recent was last week when i went to the e.r with chest pains and when they did the cath procedure they found the 2 blockages. I guess my question is, can either of u 2 help me also in finding out, if i should get a bypass. I also have uncontrolled High Blood Pressure. I don't think they can put any more stents in the RCA and I know that within 2-3 months I'll be back in the hospital. Also, I wish You 2 the best of Health.
Joe, Retired Amy, Jax, Florida, USA, 9 May 2001

• Dear Barbara: I have the same symptoms that you have! I have also been told not to worry! Have had three angioplasty procedures with a total of two stents and two "rotoblatures" ["Rotablations" -- ed.] since October 1999. (Last one in January, 2000) Have been told I should not be dizzy or light-headed and should not have arm pain. (Both arms ache.) I know my pain is real and something is wrong.. Please let me know if you have found the cause and a possible solution. (Also, I am a 46 yr. old male.) Thank you!
John D., Ohio, USA, March 12, 2000

• Barbara, Usenet newsgroups are often an excellent way to join into a community. They've been around longer than the World Wide Web or the "chat rooms", run by corporate entities. You can find a listing of the relevant cardiology newsgroups at the bottom of our LINKS page. I would recommend the support group for angioplasty patients alt.support.angioplasty. It's a relatively small group of patients, but among them they have quite a few stories to share. If you have trouble getting onto the group, talk to your ISP (not all newsgroups are carried by all ISPs) or contact them via deja.com. Good luck!
Forum Editor, PTCA.ORG, February 16, 2000

• I had 4 angioplasties in 1 year. The last was 2/3/00. Does anyone else have a feeling of a tight band around their left arm? Have it most of the time. I also have numbness in my fingers & toes and the tips of the fingers are actually purple. This happened yesterday and then I felt lightheaded and dizziness. I called my Doctor and he told me not to worry, but how can you help it? Would like to hear from others with any type symptoms after/before their procedure that would make them feel that things are not okay. I need a support group to help me with my anxieties as I have no faith that this will not happen again. It's driving me crazy and interferring with my work and life. I am 62 and need to work. Any support will be appreciated. Thanks.
Barbara Mollberg, Milwaukee, Wisconsin, USA, February 16, 2000

• On Dec 1, 1999 I had a "mild" MI. Angiogram performed showed about 95% blockage of the LAD. Angioplasty with 3 stents performed. Well about 3 weeks ago I started to notice numbness in both arms from elbows down (Same with MI) A Cardiolite stress test was performed and showed there to be blockage at the original sites as well as down from site. Question is at this point do I just elect for Bypass? These angioplasties are not cheap and if they keep coming back so quickly what is so wonderful about them? To me sounds like better to be opened up and have the grafts performed and be done with it? Or does restenosis occur as often in bypass? Thanks.
Gary McCleary, Roseburg, Oregon, USA, February 8, 2000

The Cardiology Patient Forum needs your help...
Donate Now!

Click here for more information about these

add your response
(Please keep your posting concise; a posting that is too long may be edited for readability) :

your email address
(email address must be current and valid; if email sent to the address
below is returned, your comments will not be posted; your email address
will not be displayed on the Forum unless you specifically request it): REQUIRED -- Check the box below to let us know you are a "real human being" and not a spambot. You must check this box for your posting to be submitted: I am a real person and not a spambot Check the box below if you wish Angioplasty.Org to "anonymize" your posting (for example, John Doe, Baltimore, Maryland, USA would become John D., Maryland, USA): please anonymize me The following information is optional. your name:

your organization:

city/state/province/country:


Please note the following disclaimer: The information contained in this web site is accurate to the best of the knowledge of Angioplasty.Org. None of this information should be viewed as a substitute for medical advice or as a consultation with a medical doctor. It is highly recommended that readers discuss any advice with a medical doctor before deciding on a course of action. Angioplasty.Org or its producers assume no liability for any actions taken as a result of information contained on this site, whether implied or expressed. Opinions and recommendations expressed on the FORUM are solely those of their authors. All submissions are reviewed and posted at the editors' discretion. FORUM submissions that are primarily commercial in nature, advertising services or products, are not posted. Any medical advice expressed on the FORUM does not necessarily represent the views of Angioplasty.Org, its producers, or of anyone associated with it, or of others appearing on this web site. Please note that this is a moderated discussion, so your response will appear after a short review.


Angioplasty.Org Home •  PatientCenter


send comments & suggestions to "info at angioplasty dot org"
read Terms of Use and Privacy statement

The Cardiology Patients' Forum
receives sole support from
reader contributions and sponsored search engine ads

Angioplasty.org is an independent educational health site
which receives support from
Toshiba America Medical Systems, Volcano Corporation, Terumo Medical Corporation
Cardium Therapeutics, Inc. and Lenox Hill Heart and Vascular Institute of NY
All content, including text, photos and video
© Copyright Venture Digital LLC 1996-2008