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Current Postings on This Page (28):
• Dear Blocked -- Sorry, but you can't unimpress
us! ;-)
Forum Editor, Angioplasty.Org, July 21, 2010
• Thank you for the direction. I have to
clarify on the Mt Kilimanjaro trek it was a 1 day or 4 hours up and
2 hours down only climb up to approx 4000
meters, not the entire mountain!
blocked but not broken, Singapore, July 21, 2010
• Blocked But Not Broken
-- your 100% blocked RCA
is a CTO (Chronic Total Occlusion). These are very difficult to open
and there is a relatively small group of interventional cardiologists
who
have the most experience in this area -- but it's still not always successful,
and the results may not afford any immediate noticeable benefit (in fact
a study was just published showing that opening CTOs may make help mollify
the
adverse effects of heart attack in another vessel, but may not lower
the risk of one in the blocked vessel). However, you just climbed what??!!
We'd wager that many with fully open coronary arteries would have difficulty
climbing Kilimanjaro in one day. You may not be finding much information
researching corollary arteries -- try looking up "collateral
circulation" -- as far as testing collaterals,
they can be seen on the angiogram, and a stress test would show if there
is a perfusion deficit (reduced oxygen) to any part of your heart -- although
it sounds like you just performed a stress test of sorts! Congratulations.
Forum Editor, Angioplasty.Org, July 21, 2010
• I was diagnosed with 100% blocked mid right coronary
and 40% in the left, as of 12 months ago. My cardiologist was unable to
clear block and stent after
90 minutes of plumbing. Now my burning question (to which have been unable to
find relevant hits) is the aspect of Corollary development. Several anecdotal
and verbal refs do exist to the corollary arterial development to support the
blocked vessel. *** Is there a definitive test to determine the extent of corollary
development?Never had angina, just climbed Mt Kilimanjaro (one day only:) regular
swim, exercise, scuba etc.
blocked but not broken, Singapore, July 21, 2010
• Oakridges -- one of the
big questions about the usefulness of trying to open a 100% blockage
(CTO) is whether the part
of the heart muscle supplied by that artery is still viable. If the heart
muscle is dead, then opening the artery will do little. There was a
study of CTOs just published in the American Heart Journal,
and the co-author was Dr. Stéphane Rinfret of Laval University in Quebec
City. Since you are in Canada, perhaps you can get some more specific
advice from that institution.
And Mikestone in Israel, same thing about whether
or not to open the CTO. And again, there are very few interventionalists
who have achieved high success rates in this procedure, but you can find
them with a little research.
Forum Editor, Angioplasty.Org, July 20, 2010
• I am 60 years old. 9 years ago I had a heart attack which resulted with
a stent implant in my LAD. 3 years ago it was determined that the stent was totally
occluded (CTO). By DAILY exercise (20 km. bike riding every morning) and extensive
diet changes, I have been maintaining a full and active life WITHOUT a bypass
(BTW I have been off the statins since 2003 due to the very negative side effects
I had experienced). What is your opinion about attempting to open the CTO in
my case?
mikestone, Israel, June 4, 2010
• My Dad had an angiogram which shows 2 arteries
100 blocked and the 3rd 90 percent blocked. Is there nothing that can
be done to help him. He's on nitro but he needs to spray 4 -5 day. He has
been told that he won't survive heart transplant. Has anyone gone through
this and what worked for you. Even if we need to get this done in the
US...please
advise.
Oakridges, Ontario, Canada, June 2, 2010
• There is a physician in Bellingham, Washington
named William Lombardi.
He is currently doing a procedure to open a "CTO" Chronic Total Occlusion". He
is using a new technology and he was able to open my CTO (in the right coronary
artery) after two other cardiologists were unsuccessful. If you are interested
please contact Cascade Cardiology in Bellingham, Washington (state). You may
also find information on the web about Dr. William Lombardi.
Elissa O., Washington State, USA, April 22, 2010
• Prasugrel is a more potent antiplatelet drug than
Plavix (clopidogrel) and therefore also carries a slightly higher risk
of bleeding complications. But it is a good alternative if one is allergic
to or resistant to Plavix. It was just approved for use in the U.S. in
July 2009. Here's more
info on Prasugrel from our Editor's Blog.
Forum Editor, Angioplasty.Org, January 10, 2010
• Hi I'm a 39 year old male and was diagnosed with a 100% Total Occlusion
of the right coronary artery 2 weeks ago. 1 week later i have had 3 drug eluting
stents put in. I considering myself very lucky. i Did have an reaction either
to the contrast or the loading dose or subsequent week of taking plavix. A horrible
skin rash which lasted 3 days. i am now on Effient. (Prasugrel Hydrochloride).
My Cardiologist says that this is a slightly better drug. but is very new. Is
there any links that can verify and give me more information Thank you.
Adam Weaver, Adelaide, South Australia, Australia, December 21, 2009
• Jenny -- did the doctors suggest bypass surgery?
Forum Editor, Angioplasty.Org, December 14, 2009
• I really need some input on my issue. My dad
did the angiogram and found out his right branch of coronary artery is
totally blocked and his two left branches of coronary arteries are 95%
blocked and cardiologist told us he is not suitable to do the stent placement.
In his situation, what can be done to save his life in this very well
developed new technology world? Please help me out!!
Jenny, Boise, Idaho, USA, December 8, 2009
• I wanted to just comment on Mr
B. Johnson, Texas, USA posting as I had the same problem.
You didn't mention your age. Where as I was just 42 with highly
sports activity & BMI 21 suddenly had 100% Occlusion in Lad its type III
ostial stenosis. Actually it all depends on how quick you reach to a cardiologist
after occlusion. I was told that if its with in just an hour enzymic treatment
would
do, if more than 2-3 hours needs intervention and as I had it for more than
8 hours before I recd a Primary PTCA with DES stent to LAD. But still I believe
stent is no good to lead normal life except but when it is only option. Now
a
days newer technologies like motorized plaque cutter catheters and most sophisticated
robotic surgeries are turning to be ideal All the best with good wishes for
your speedy recovery...Er CVK Nageswara Rao
C V K Nageswara Rao, Avikanagar, Rajasthan, INDIA, October 4, 2009
• Workemail -- read below several entries that discuss
"collaterals" -- a mesh-like grouping of small arteries that
can form a bypass of a total occlusion. Usually the blood flow of these
collaterals
is less than a normal artery, but they may provide enough to avoid significant
ischemia. Why the blocked artery wasn't bypassed is impossible to say without
specific medical records, angiograms, etc. Stenting or angioplasty was
probably not recommended because of his complex situation, although we
daresay there are a number of interventional cardiologists who might have
attempted it and met with success as well.
Forum Editor, Angioplasty.Org, July 10, 2009
• A close friend of mine's father just went in
for triple by-pass surgery. They were only able to do a double due to one
total blockage. The doctors told them, however, that the blocked artery
had already rerouted itself so it had
actually "fixed" itself. He is still in the hospital and isn't healing very well
(infection). Would there have been another route they could have taken for him?
Workemail, Indianapolis, Indiana, June 30, 2009
• Jane G. -- from your post, we're assuming you
have had bypass surgery, but we're unclear whether you've been looked at
by an interventional cardiologist. Bypass surgery is done by cardiac
surgeons; stenting and angioplasty is done by interventional cardiologists.
These are two separate specialities, although they often work together. There
are a number of expert cardiologists in the New York area who specialize
in opening total occlusions (e.g. Columbia University Medical Center is
part of a total occlusion
summit held annually in NYC).
Forum Editor, Angioplasty.Org, June 29, 2009
• I have 100% blocked artery and live on the vein
they took from my leg. And one other vein that is so weak and diseased
that they could not put a stent in or anything. What can I do to unblock
the arteries? Can you be good enough
to help me?
Jane G., New York, USA, June 25, 2009
• Judy -- chronic total occlusions (CTO) are very
challenging for the interventionalist to open -- there are a number who
specialize in this, but the question (as with all procedures) is why do
it? There is debate in the interventional medical community as to whether
opening a CTO is necessary if collaterals have taken over much of the burden
and the EF is in the near normal range. And, of course, how to successfully
re-open the CTO. There are summits organized
addressing just such issues. The question is whether
your husband
is having
symptoms
that can be resolved only through
revascularization
(re-establishment
of blood flow, whether through angioplasty or bypass) -- or possibly whether
his condition warrants a bypass to prevent a future event. These are complex
questions, and much depends
on the very specific clinical details of your husband's condition. We
would suggest consulting both an interventional cardiologist AND bypass
surgeon -- to get a sense of whether further procedures are necessary or
helpful.
Forum Editor, Angioplasty.Org, May 20, 2009
• My husband had an angiogram showing 100% blockage of the LAD (yikes).
Being an overweight, poorly controlled diabetic with labile hypertension, it
was found he had had an MI with damage to anterior wall and apex and had not
known it. Fortunately several collateral vessels had developed and evidently
feeding the remaining muscle since his EF was 45%. The interventional cardiologist
tried for 5 hours to open the blockage but was unsuccessful. The suggestion is
that my husband have an off pump bypass. Is this bypass necessary even though
there is some collateral circulation? Thank you.
Judy K., Texas, USA, May 19, 2009
• Trevor -- the re-opening (revascularization) of
total occlusions is a specialized area of angioplasty and stenting. The
big question is "how will re-opening the occluded artery affect the
patient's clinical status". Often collaterals, small branches, form
around the total occlusion forming what some call a "natural bypass". The
success rate really depends on specific anatomical characteristics, and
on the age of the occlusion. Obviously a chronic old calcified total occlusion
is very difficult. Also total occlusions tend to restenose at a higher
rate. But there are big debates on this subject within the cardiology community.
Forum Editor, Angioplasty.Org, March 10, 2009
• I'm finding it hard to find answers on stenting
total occlusions. One of my arteries is 100% blocked and my cardiologist
has booked me in to stent it. I know that stenting is pretty common,
but is it common with total occlusions? Also, what is the success rate
with
stenting total occlusions? This is due to happen in three weeks, a quick
response would be great.
Trevor, Australia, March 2, 2009
• At 53 I had a 95% circumflex artery blockage
that was successfully stented. During the procedure they discovered
the right coronary artery was 100% blocked at its base and was calcified.
They could not get a wire through this calcification but there was good
collateral
circulation to that area of the heart. My question is how common is
this?
They do not wish to do a bypass or try to fix the RCA because the damage
is already done. I still exercise daily but it takes me 10 minutes
to warm up before I can do strenuous activities.
Leeg, British Columbia, Canada, August 31, 2008
• Marjory -- completely blocked arteries are called
"total occlusions" and, if they have been blocked for some time, they
are considered "chronic". If surgery is not possible in your
case, you may want to consult an interventional cardiologist who specializes
in Chronic
Total
Occlusions or CTOs. There are not many because this is a very difficult
area, but not an unknown one. For instance, last month we attended
a live demonstration course in New York where Dr. Shigeru Saito of
Japan opened three total
occlusions
in one
afternoon. He is one of the world's experts in this field. The Cardiology
Research Foundation (they put on the big TCT interventional cardiology
meeting in Washington every fall) has
a special annual meeting devoted to CTOs. All this is by way of saying
that CTOs are done, but by cardiologists who specialize in them. Perhaps
contact
the Montreal
Heart Institute -- they are a major center and may have physicians
who do CTOs.
Also it is very hard to evaluate a CTO with a standard
angiogram, which
shows
a 2-dimensional "shadow" image of the arteries. Most cardiologists
want to see a CT angiogram, or multislice CT, which gives much more detail
about the occluded area (how long, whether the plaque is hardened, etc.).
Finally, very often in such cases, the body manufactures collaterals,
which are smaller arteries that deliver some blood flow. Good luck and
let
us know what you find out.
Forum Editor, Angioplasty.Org, May 4, 2008
• I have had an angiogram
which shows 2 arteries 100 blocked and the 3rd 90 percent blocked.
Is there nothing that can be done to help me. I am on .08 nitro patches
during the day but at night I take them off but need my spray 3 or
4 times a night. I sleep sitting up. Am I really just waiting to
die? Apparently I cannot have bypass as the arteries are so blocked
there
is nothing to sew the bypass onto. What about something to clean
out the plaque somehow? I heard something about cold laser.
Marjory Sturgeon, Prescott, Ontario, Canada, April 27, 2008
• Did you find any solution of your problem? I have recently got my angiography
and my LAD is also 100% blocked at two points. Two well known cardiologists have
suggested angioplasty and they claim that they can handle the problem whereas
4-5 specialists have concluded that bypass is the only solution to the problem.
Tariq Mahmood, Pinstech, Pakistan, June 1, 2004
• My mother in law,
who is 82 years old recently under went an angiogram which revealed
3 totally closed arteries and three partially closed arteries. What
are her options?
Joseph Sartori, Colonial Beach, Virginia, USA, September 5, 2003
• Are
there any new techniques to get the guide wire through a chronic restenosed
total occlusion in the RCA? One reason I was hoping this is the case,
that the the August 5, 2001 article in Circulation by Dr Gregg W Stone
regarding the new clot busting drugs prior to angioplasty improve results.
Besttt, September 14,
2001
• LASER,
special PTCA wires, sometimes Rotablators However, the clot busting
drugs don't tend to work on chronic lesions such as the one you mentioned
as they work on reasonably fresh clots. LASER wire is certainly an
option, you need to find a centre that does it though! I hope this
helps you
Andrina, Prince Sultan Cardiac Centre,
Riyadh, Saudi Arabia, February 10, 2002
• I recently had my first angiogram performed.
It showed a 100% blockage in mid LAD. My Cadiologist said that he could
not open
this blockage with angioplasty and that surgical bypass would be necessary.
Due to my health and age this would be rather risky. Anyone who knows if
and where I could get angioplasty performed on this 100% blocked coronary
artery please let me know.
Burnett Johnson, Retired, Baytown, Texas, USA,, May 20, 2001
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