posted by Long Islander, Long Island, New York, USA,15 Mar 2002
Bypass a better option?? I am a 49/M that had my LAD cleared in 1991- no stent- that was found still clear after an annual thalium showed a problem in my right coronary last week. So the right was cleared- 95% blocked- and a stent was put in- no problem- but 5 minutes off the cath table, on the way down to recovery, I had huge chest/neck pain and rushed back up. It was described to me that the artery had dissected- the surgeon tried for an OR to bypass, but they were occupied- so he went in the other leg and put in 9 more stents. The doctor saved me,no question. My question, and bear in mind I have total faith in the care I've been given, I'm so lucky that circumstances weren't different- I've been told 10 stents is OK and barring another occlusion I'm good to go, so to speak. Is the bypass option a better one, given my age, rather than all these stents?? No MI as a result of the glitch I was told, enzymes went up, than back down, I was released the next day (and by the way-what's a dissection??). ! If anyone could give me any info- it would help my peace of mind.

• Hi Long Islander Basically a dissection is a tear in the artery wall, bearing in mind that artery wall is pretty delicate and has 3 layers. If you damage it ( Eg during stents and / or angioplasty), you can tear the lining of the artery which can act like a flap and it can run all the way down the artery ( like a ladder in stockings), there is no way of knowing where or when it will end. This can be a little dangerous if not treated as the blood that is going through the artery will be trapped within these layers of the artery. The best way of dealing with this is by stenting to "tack" back the flaps to keep the artery open, but you may find that you chase the dissection all the way down the artery and end up using quite a few stents!! You are still pretty young so maybe bypass is not the best option at the moment, the artery is now open and that is the main thing. You now need to look after your blood pressure, cholestrol and smoking, etc and keep on you medications. If you begin to feel unwell or have twinges or pain, make sure you tell your cardiologist. All being well, you will be fine, and bypass is an option you may need to explore should your symptoms return , this is something to discuss with your physician as and when ( and if) the time comes. I really hope this makes sense and hope i have helped a little!
Andrina Hargreaves, Clinical educator, PSCC, Riyadh, Saudi Arabia, 26 Mar 2002

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