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Can A Total Occlusion Be Stented?

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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.
B. Johnson, Texas, USA

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Current Postings on This Page (58):

• Rana D. - Not quite sure what you mean by "Proximal RCA after LCX has 99% tight lesion." The LCX is a coronary artery on the left side. But if your mother is right dominant (meaning that the right artery is the main supply to her heart) and it has a 99% proximal blockage (meaning near the origin from the aorta) then that is most likely the source of her angina and is certainly of concern. If medications have not provided sufficient relief, opening that up physically through angioplasty is usually considered the next step, to provide increased blood flow and ease the angina. Please note that this is NOT medical advice, and any questions about her care should be referred to a cardiologist.
Angioplasty.Org Staff, Angioplasty.Org, July 21, 2013

• My mother (59 years) has been detected (Nov.2012) Single Vessel Coronary Artery Disease. Doctor's observation: RCA: Dominant. Proximal RCA after LCX has 99% tight lesion and Recommended for PTCA to RCA. I wish to know (I) The Blockage percentage, and (II) Whether immediate angioplasty/operation necessary. She is now on regular medicines but often experiences pains in chest. Please advise me.
Rana D., Kalyani, West Bengal, India, July 21, 2013

• Ashish in India - Your report states that you've had an anterior wall myocardial infarction (AWMI), a heart attack no doubt related to the totally occluded mid-LAD, which is preventing blood flow down the LAD and into the anterior part of the heart muscle. None of the other vessels have a significant blockage. The only reason to attempt an angioplasty would be to open up the 100% blockage and that is a complex decision. One factor is whether or not the anterior wall heart muscle is still functional post-MI. If it is not, opening up the blockage will probably have little benefit, although there are cardiologists who might debate that. We also don't know whether your circulation is right-dominant, in which case the RCA is doing the majority of the work anyway, or the status of collateral circulation (a kind of natural bypass around the total occlusion). We can't give you medical advice, especially on such a complex issue, but medical management (and lifestyle modifications like smoking cessation, diet, exercise) seem like a reasonable first step. Opening a total occlusion can be difficult technically so most cardiologists would want risk-benefit ratio to be clearly in the patient's favor before moving ahead with that.
Angioplasty.Org Staff, Angioplasty.Org, July 3, 2013

• CORONARY ANGIOGRAPHY REPORT: LM: NORMAL; LAD: proximal LAD had 50% stenosis; mid LAD had 100% occlusion; ramus: prox ramus had 40% stenosis; LCX: NORMAL; RCA: NORMAL; RENALS: NORMAL; IMPRESSION: IHD WITH AWMI WITH SINGLE VESSEL DISEASE. ADVICE: MEDICAL MANAGEMENT is the advice correct or is there any need of angioplasty? Since doctor said it's not required.
Ashish, INDIA, July 3, 2013

• Sophie - We're guessing from your description that the interventional cardiologist is attempting to open a CTO, or Chronic Total Occlusion, where your friend's LAD is completely blocked. (If this is not the case, please post more details.) There are several techniques used to attempt the CTO, and the bi-femoral approach is one. Basically, the total blockage is a blank area on the angiogram, since no blood circulation or contrast dye can pass. So using two wires, the blockage is approached from both ends, to aid in visualizing the exact channel (kind of a connect-the-dots technique). Opening CTOs is a very challenging procedure techically and it is done by cardiologists who are experienced in this particular specialty. Another technique that has been used successfully is a radial/femoral combination, using access from both the wrist and groin arteries, or even a radial/radial, where both left and right wrists are used. Dr. Shigeru Saito of Kamamura, Japan, one of the world's experts in CTO, has demonstrated this technique with great success.
Angioplasty.Org Staff, Angioplasty.Org, June 28, 2013

• My friend was recently admitted to hospital for an angioplasty antegrade (bi) femoral approach - however this had to be aborted as it was not possible to get wire to LAD? He is to be re-admitted on 12 July for angioplasty but this time retrograde (bi) femoral approach. My questions to you is, is this something that happens quite often and what are the main reasons for not able to get wire to LAD? The consultant at his initial consultation was 70-80% confident (after reviewing angiogram) that he could get wire to LAD If retrograde femoral approach is not successful - what are the options? Many thanks
Sophie, London, United Kingdom, June 28, 2013

• Sharma -- if angioplasty and stenting is an option, it's nothing something that can be stated definitely over the internet, but we'd suggest consulting an interventional cardiologist who has experience in working with previous CABG patients. For example, President Clinton had two of his bypass grafts close up, and he wound up receiving stents in the original native vessels.
Angioplasty.Org Staff, Angioplasty.Org, March 28, 2013

• Hello, My father had his open heart bypass surgery in 1996. Last year, he had an unstable angina while walking for more than 5 minutes. Doctors performed an angiography which revealed that 2 of his grafts have been blocked again. Please see the report below:-Grafts to OM1 and RCA blocked 100%: Distal vessel and OM1 filling by collaterals from LAD, Distal vessel and PDA filling by collaterals from LAD.-LIMA to LAD Patent- ECG, EKG : Normal. He was discharged on medical management advise. Although, there was another hospital we went to for a second opinion and they said he would need a second by pass surgery. He has an active lifestyle. My question is does he require a by pass surgery again or stents is an option for him? Thanks.
Sharma, R, BMS, New Jersey, USA, March 25, 2013

• I live in New York and my Doctor opens 100% blockage and uses some new laser also...but it's in new york...Dr.Strizik or Dr. Anto ....Huntington Long Island New york
Vin, Long Island, New York, USA, March 2, 2013

• In the current technical world CTO angioplasty and stent is an an option for any patient with clinical indications. symptoms, viability or ischemia the same reasons you would be placed on medications or offered bypass surgery. The limitation to CTO PCI is operator experience and education and there are now a growing number of expert centers both in the US and the world that can offer these procedures to a much broader patient population than most cardiologists would believe.
Bill, PeaceHealth St Joseph Hospital, Bellingham Washington, USA, April 15, 2012

• mi chiamo Ottavio,ho 65 anni,il 30 marzo 2012 sono stato sottoposto ad un intervento cto con la nuova tecnica di "rivascolarizzazione per via retrograda".L'intervento è servito per disostruire la coronaria destra totalmente ostruita da 12 anni ed è durato circa tre ore ed ha avuto un ottimo risultato grazie alle mani esperte alle quali mi sono affidato e al quale manifesto la mia profonda gratitudine.Grazie Italia,Ospedale Cannizzaro CT e grazie soprattutto al grande esperto prof. MASAHIKO OCHIAI.

[Editor's translation: My name is Ottavio. I am 65 years old. On March 30, 2012, I had an intervention to revascularize my Chronic Total Occlusion (CTO) using a new technique of retrograde angioplasty. The procedure was performed for the Right Coronary Artery (RCA) which had been totally obstructed for 12 years. The procedure lasted approximately three hours and had an optimal result, thanks to the expert hands entrusted to me and to whom I am deeply grateful. Thank you Italy and Ospedale Cannizzaro CT...and thanks, above al,l to the great expertise of Dr. MASAHIKO OCHIAI!!

Editor's note: Ottavio is an inventor and has a series of YouTube videos -- one of which he included -- his thoughts on creating a "safe" catheter for directional atherectomy:
Ottavio, Italy, April 12, 2012

• All, Very interesting discussions. A Canadian CTO registry just published suggests that attempt rates are variable (1-16%) between institutions. A study of US patients I published in 2009 suggested that you are half as likely to have a CTO attempted if you have a low volume compared to high volume interventionalist on your case. Therefore, the care you get depends more on who you see than on what you need. There are CTO experts and those who claim to be, but aren't. I assure you all of the faculty at are experts.
Dr. G from K. C., Kansas City, Missouri, USA, April 12, 2012

• Abhay -- thanks for posting additional (extensive) info. As we wrote, this is not the place for a second opinion. However, we can say that the reason perfusion imaging (a nuclear stress test) is being recommended is to see if the part of the myocardium (heart muscle) supplied by the occluded LAD is viable. If it is not, then opening the LAD total occlusion probably will not make a difference. However, if the part of the heart supplied by the LAD is viable, but not getting sufficient flow from the collaterals, then opening the chronic total occlusion (CTO) might be a way to go. CTOs are not easy to open (especially one that is old. They and carry a higher risk for complications like artery perforation, etc. If you, your father and your cardiologists do decide to go this route, make sure you go to an interventional cardiologist who is expert in working with CTOs -- it's kind of a sub-sub-specialty. Let us know how things work out.
Angioplasty.Org Staff, Angioplasty.Org, April 8, 2012

• Thank you for your reply! But can you please advice if Angioplasty is advisable on 100% blocked artery (LAD)? My Father had a Heart Attack in Dec-2006 but had not done any Angioplasty. Had Angina a week back.
Angiogram Report:

  • LMCA: LMCA is long and has mild lumenal irregularities, no flow limiting disease.
  • LAD: LAD-ostial proximal LAD has 30% tubular lesion, followed by total occlusion of LAD at proximal-mid junction. There is faint, incomplete opacification of LAD through collaterals in RCA injection.
  • D1: - D2: -
  • LC: LCx is good size vessel, proximal LCx & major OM (2.75 mm vessel) are normal Distal LCx after origin of major OM is small caliber vessel, it has mild luminal irregularities, no flow limiting disease.
  • OM1: Large, Major OM is 2.75 mm vessel & is normal
  • OM2: OM2 is small vessel, no flow limiting disease RCA: RCA-Dominant, 3.0 mm vessel, mid & distal RCA has mild luminal irregularities, no flow limiting disease. There is faint incomplete opacification of LAD through collaterals in RCA inject.
  • PDA: Arises form RCA & Normal
  • PLV1: Arises form RCA & Normal
  • PLV2: Arises form RCA & Normal
  • L.V. Angiography: Not performed
  • Recommendation: Advise-myocardial perfusion scan for viable assessment in LAD territory.

Can someone please advise is Angioplasty is possible in this case. Thanks!
Abhay, Can A Total Occlusion Be Stented?, India, April 7, 2012

• Abhay in India -- Your post is a bit "off-topic" since this thread is about total occlusions. We're not sure why your father's doctors recommended angioplasty when they were not sure what the severity of the blockage was after looking at the angiogram. (We assume that this was an invasive angiogram done in a cath lab, and not a CT Angiogram.) Angioplasty should really only be done in blockages that are significant. Otherwise medical therapy should be tried first. In any case, you're sort of requesting a second opinion, but sorry...we're not the place to go. He needs to see a cardiologist, preferably an interventional cardiologist, to look at the angiogram, along with his medical records, and assess whether angioplasty would be of benefit. We would recommend that you accompany him to the appointment, as well, if possible.
Angioplasty.Org Staff, Angioplasty.Org, April 7, 2012

• My Father had an Angina around week back, Doctor advised to go for Angiogram as per them there might be 2 Blockages but as per Angiogram there was only 1 Blockage in LAD (as per them they are not sure how much %age of Block is it) and they suggest to try for Angioplasty. I am not sure if we should go for it. Can someone please check the Angiogram and suggest me. (Also, please guide me how to upload the Angiogram here so that you can look into it) Thanks so much for your help !
Abhay, Can A Total Occlusion Be Stented?, India, April 7, 2012

• Gerald in Washington DC -- Chronic Total Occlusions (CTO) are challenging for interventional cardiologists to pass through and re-open. Yours, being at the LAD/Circ, is doubly so, because the blockage is at the bifurcation of the two arteries. As we have mentioned in this Forum Topic, treatment of these blockages is a specialty within interventional cardiology -- i.e. there are cardiologists who are expert in assessing and attempting to open such blockages. You will tend to find them at major interventional centers -- and the Washington area has several of these. However, it may be that this is too difficult to do, and also that your other arteries (or collaterals) may be compensating somewhat. We would suggest getting a second opinion from an expert in CTOs, if you haven't already consulted one. Meanwhile, reducing your controllable risk factors is absolutely the correct path: watching diet, smoking cessation, adherence to prescribed meds, etc. The fact that your other arteries are not significantly diseased is, of course, a very positive sign.
Angioplasty.Org Staff, Angioplasty.Org, April 2, 2012

• Looking for direction. My anterior descending coronary artery is 100% occluded at the intersection of the circumflex coronary artery. Other arteries are 80% or more open. I am 43 and in otherwise good health, my heart muscle is not damaged, and I have changed my diet to Dr. Esselstyn's (low fat, no oil). Total occlusion is believed to have occurred 4 months ago. I have mild angina with any exercise, such as after 1/3 mile on a stationary bike. Angioplasty was attempted but aborted because of the blockage's total occlusion and location.
Gerald, Washington, DC, USA, April 2, 2012

• There is a new website with CTO expert physicians from across the country,   Click on Physician Education then click Faculty. There may be a physician on that list near you!
Jim, Kansas City, Missouri, USA, March 21, 2012

• I have been having episodes of sweats, high blood pressure, chest tightness, burping, arm pain and chest pain. Recently I went to the ER (should have gone before but I don't have insurance due to being laid off) and they told me I needed a stress test. I failed the stress test so they kept me in the hospital and did a heath cath. The heart cath revealed a 100% blockage on the right side of my heart and 3 blockages on left in the 30s and 40s blockage rate. They told me I don't need a stent or anything because I had "collateral circulation" and sent me home. I am still having chest tightness, etc. They put me on a lot of medicine but I am worried. Will this medicine and eating right, etc. cure me alone?
Frank, Unemployed needing help, Florida, USA, August 29, 2011

• Very Very Worried in Houston -- Thanks for posting. (A note for those wishing to view the angiogram links in Worried's post will need to use Internet Explorer and it requires a plug-in to be installed from Camtronics.) Your case is complex, what with the flow dynamics having changed from your native circulation to the bypass situation. These angios really need to be interpreted by an interventional cardiologist. If you have specific questions, since your angios are available on the net, you might want to get a second opinion...specifically from an interventional cardiologist in your area who specializes in total occlusions. From our quick (non-MD) look, it seems that the total occlusion in your Right Coronary Artery was not present before the bypass. The fact that the occlusion is just past the graft site points to some potential issue there. The collateral circulation is not clearly visible in the pre-bypass pix, mainly because there was no total occlusion yet. But isn't the right bypass graft supplying the heart as well? Again your case is complex; you should discuss this with a cardiologist -- and ask questions until you understand your situation. By all means report back to the Forum with your results.
Angioplasty.Org Staff, Angioplasty.Org, August 25, 2011

• I had a triple bypass 4-23-10. I exercise at least 30 min 5 days a week. Cholesterol is 180.Diabetes A1C is 5.9. Triglycerides is 84.I take Plavix. After triple bypass I felt terrible. I was worse than before. Before, I had mild chest pain after running a mile. After surgery, I could not walk 30ft without being short of breath. I told my doctor post surgery,at 6 months, and 1 year checkup that I was still short of breath and had what I think is called postural hypotension. I was given a stress test at my 1 year checkup which came back abnormal. Doctor said I needed an angioplasty in a worse case scenario. I ended up with a stent in the OM and have been told that my lower RCA is 100% blocked just past were the graft was done.My LVEF is now 40% as it was before my bypass. I am told the blockage can not be fixed and collateral veins have grown around the blockage. I have done everything I can to prevent this. How long has the blockage has been there? How long it takes for collateral veins to grow and can you tell their age by their growth development.
4-23-10 before bypass
8-4-11 before/after stent
Very Very Worried, Houston, Texas, USA, August 25, 2011

• Forum Editor Totally Rocks!!!
blocked but not broken, Singapore, February 10, 2011

• I am 44 years old and had angioplasty Dec. 2010 with 7 stents 2-100%, 1-75% blockage. They tell me my stents are medicated. I had very little symptoms that i was aware of other than a heart burn sensation. I am grateful to my doctor for conducting this procedure.
Brian, Worcester, Massachusetts, USA, January 21, 2011

• Two totally occluded arteries would tend to indicate that bypass surgery, not stenting, may be the appropriate therapy -- this might be debated by some interventional cardiologists and you might want to consult one, especially one who is very experienced in opening total occlusions (it IS a bit of a specialty within the specialty) -- every patient's clinical situation is different and perhaps your friend's father's may be more amenable to an intervention (as opposed to open surgery) than it seems. But bypass surgery has been around a long time and is faster and less complicated in experienced hands than ever. One question, of course, is the current status of his cardiac muscle -- how much damage did it suffer in the heart attack? and will opening thise arteries provide him with greater cardiac function?
Angioplasty.Org Staff, Angioplasty.Org, January 10, 2011

• My friend's father recently suffered a heart attack and was advised to undergo angiography. The test showed 100% blockage in two of his arteries and was recommended open heart surgery. He is 61 years old and has suffered from hypertension and high blood pressure for the past 3 years. He has lived with the fear of doctors and surgeries all his life and is now strongly refusing to undergo the surgery. No amount of convincing from the doctor or the family seems to help. There seems to be very little chance that the patient might change his mind about the surgery. In such a case with his condition, are there any alternatives to a bypass? Or is there any other temporary solution he can take up till the family manages to talk him into surgery?
ahsin26, Mumbai, India, January 10, 2011

• Jim S in California -- the fact that all your tests were normal before discovering the total occlusion on the angiogram might indicate that the corollary circulation is indeed sufficient, although the Left Anterior Descending (LAD) is a major coronary artery -- it might also be that your heart is "right dominant" and it is the right coronary artery that is the main supply. The decision to open a total occlusion with a stent is debated often by cardiologists. There is, of course, always the possibility that a complication may arise because this can be a challenging procedure, especially in an old chronic total occlusion. However, there are a number of interventionalists who feel that if one can open a total occlusion, one should. The fact that you have corollary circulation would tend to indicate that your artery has been completely blocked for a while now. Changing this situation is a matter of assessing the risk-benefit -- you may want to get a second opinion, if only to feel reassured in your decision.
Angioplasty.Org Staff, Angioplasty.Org, October 25, 2010

• Hi, I am a 67yr old male; just has first angiogram and 100% blockage was indicated in LDA (I believe). My Cardiologist wants to do a stent, and I am hesitant, because, he also informed me that corollary arteries have formed a natural bypass. I am experiencing relatively stable angina with what seem to me minimal pain; when it occurs, I usually take a 0.4mg Nitro sublingual. Currently taking Plavix & Bystolic. I don't smoke, have lost 30 lbs in the past 3 mos, and have changed to a low fat, heart healthy diet. If I postpone the procedure, is it reasonable to expect the angina to clear? And if it does not, is the stent a better option to minimally invasive or robotic bypass surgery? Interestingly, all my ECG, EKG, Chemical Stress Test, etc, were normal, prior to the angiogram.
Jim S, Capitola, California, USA, October 13, 2010

• RusK in Illinois -- as with any invasive medical procedure, there is a risk, albeit slight, of a complication when doing an angiogram. A standard stress test (non-nuclear) might suffice to test if there is any problem with your heart. You should discuss the risk-benefits with your cardiologist.
Angioplasty.Org Staff, Angioplasty.Org, October 12, 2010

• Approximately 5 years ago I had a 98+% blockage of the proximal LAD which was subsequently stented. Essentially asymptomatic except slight ischemia determined from stress test for ventricular quadrageminy. 4 months later, mid-RAD stented due to 75% blockage -- could have been done in the initial procedure. Took plavix for 1.5 yrs. Due to an irregular heartbeat, I have been on coumadin, etc., for 10 years. Last year, had a pulmonary vein isolation ablation which largely corrected arrhythmia. Question: in light of no symptoms on original LAD stenting, how often should I have an angiogram? Concerned that a blockage/stroke will sneak up on me. Age: 62.
RusK, Bloomington, Illinois, USA, October 5, 2010

• Dear Blocked -- Sorry, but you can't unimpress us! ;-)
Angioplasty.Org Staff, 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.
Angioplasty.Org Staff, 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. Stιphane 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.
Angioplasty.Org Staff, 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.
Angioplasty.Org Staff, 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?
Angioplasty.Org Staff, 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.
Angioplasty.Org Staff, 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).
Angioplasty.Org Staff, 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.
Angioplasty.Org Staff, 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.
Angioplasty.Org Staff, 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.
Angioplasty.Org Staff, 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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