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Current Postings on This Page (15):
• 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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