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Can A Total Occlusion Be Stented?
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Current Postings on This Page (58):
• 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.
• 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.
• 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
• 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. • 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 • 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. • 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. • 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 ctofundamentals.org are experts.
• 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.
Can someone please advise is Angioplasty is possible in this case. Thanks!
• 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 !
• 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. • There is a new website with CTO expert physicians from across the country, www.ctofundamentals.org Click on Physician Education then click Faculty. There may be a physician on that list near you! • 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? • Very Very Worried in Houston -- Thanks for
posting. (A note for those wishing to view the angiogram links in Worried's
post below...you 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. • 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. • Forum Editor Totally Rocks!!! • 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. • 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? • 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? 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. 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. • Dear Blocked -- Sorry, but you can't unimpress
us! ;-) • 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
-- 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. • 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. • 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. • 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? • 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. • 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. • 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. • 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. • Jenny -- did the doctors suggest bypass surgery? • 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!! • 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 • 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. • 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? • 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). • 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? • 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. • 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. • 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. • 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. • 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. • 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. • 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. • 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. • 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? • 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. • 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 • 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. |
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