Can Small Arteries Be Stented?

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• my age is 32 lmca 35% rca70% and have diagnals thin vessels one cordiologyst told that your viens is very small that condition is not comfort to cabg you continue old medicine. but what is the my heart condition I dont know. now I have a any serious conition? please give reply anybody for my doubt ramakrishna,uae.
what is my health condition, electrical, ras al khaimah, United Arab Emirates, August 18, 2010

• Madmatt in Missouri -- Stents only go down to a certain diameter -- we believe 2.25mm is the narrowest. Although a balloon angioplasty can still be performed in a narrow vessel -- just no stent left behind, so reclosure is a higher risk. Did you cardiologist do a balloon dilatation? FYI, even after angioplasty and meds, a not insignificant number of patients still experience angina -- there are anti-anginal medicines, such as Renexa (Ranolazine) that may relieve the pain.
Forum Editor, Angioplasty.Org, June 30, 2010

• I'm a 40 year old male quad bypass in 04' recently I've had angina and pain in the back of my arms, my cardiologist tried to perform a stent on a horizontal artery, it was too small and is now treating with meds, I'm still having angina and anxiety. I've been assured that this will pass as all other vessels seem well. Question... when will the hurting stop? except for this small vessel I'm great but it's very frightening.
Madmatt, Independence, Missouri, USA, June 24, 2010

• Carl Laurino, I sure would get another opinion at one of the top notch hospitals in New York City. David Letterman and Regis Philbin (sp) both used the same highly qualified group of doctors at Cornell-Weill Teaching hospital there in NYC. I also see doctors at a Cornell Weill based hospital in Houston. I also was told by cardio's that I have an area in the distal LAD that cannot be stented or by-passed. Some new smaller stents came out but were still too big for my tiny artery. I am treated medically until a time comes that the best stent for me comes on the market. I know how frustrating it is. No two cases are the same and I suggest you need another opinion at a large teaching hospital with experienced cardiologists. We all deserve and need this. I wish you all the best.
Kathy Laurio, Houston, Texas, USA, July 26, 2009

• MB -- this is really a question for your uncle's cardiologist. It may be a question of your uncle's clinical status -- that is, he may be too ill from other problems to withstand an operation. This situation is one where interventional procedures, such as angioplasty, may help because they are far less impactful on the patient's system. But perhaps the blockage or blockages are in difficult-to-access locations, or are chronic total occlusions which are not able to be opened. Or perhaps the blockages are in arteries that are too narrow. We'd suggest talking to your uncle's cardiologist and asking more specifics so that you can help your uncle understand, or perhaps you may want a second opinion. Every month newer and newer stents are being designed that will better stent narrow arteries. Regarding speaking to the cardiologist, we recommend to all our article, "You and Your Physician". Let us know what you find out.
Forum Editor, Angioplasty.Org, July 22, 2009

• My uncle's cardiologist said my uncle was an inoperable cardiac patient. Does this mean he would not be a candidate for bypass and angioplasty or does this just refer to surgery, bypass?
MB, Massachusetts, USA, July 15, 2009

• Eve -- you report that your artery was 95% closed. Which artery is this and what did the cardiologist advise?
Forum Editor, Angioplasty.Org, May 15, 2009

• I am a 63 year old woman with unstable angina. The doctors did not take me seriously because I passed all the tests with flying colors. Only when I asked what they would tell my family I died from did they take a look and found the artery was 95% closed. I continue to have angina attacks that I really feel I am going to die. The doctors can not find a problem. If it is the small microscopic arteries or hardening of the arteries there is nothing they can do. Do I take my nitro until I have a stroke or have an aneurysm. This is very scary and I have no answers.
Eve, Michigan, USA, May 10, 2009

• at 32 yo, i had 80% blockage of my LAD-stent was placed. at 36, my cardiologist could not get into my 1st diagonal branch. he said it is unable to be stented. i have chest pain and sob. what do you recommend?
Karen, Monroe, Louisiana, USA, May 7, 2009

• I just had an angiogram done and was told the right coronary artery was too small to do angioplasty and that it would compensate on its own. Is this true or do I need to see another cardiologist?
Susan C., Georgia, USA, May 30, 2008

• Z.-- best person to ask is an interventional cardiologist -- the specialist that does angioplasty and stents. Have him/her look at your grandfather's angiogram. They will be able to see the coronary anatomy and determine if stenting is possible and would be therapeutic.
Forum Editor, Angioplasty.Org, May 16, 2008

• Hi my grandpa just had a heart attack they couldn't do surgery because he had small veins/arteries. would a stent be an option for him?
Z., Wisconsin, USA, May 14, 2008

• C.S. in San Francisco -- if a 3mm stent was used, that's not a "small" artery (small would be as you approach a 2mm diameter). If your heart attack was caused by a subtotal blockage in your circumflex, then the stent will keep that lesion open, preventing future episodes, something that cannot be done via meds alone, etc. And the risks that you read about are small -- for example, late stent thrombosis is a very low frequency event. All good practitioners are against putting in stents when they're not needed, but it would seem in your case (and this is NOT a substitute for a qualified medical opinion) it was needed. Furthermore many patients who have had angioplasty and stents go on to continue full lives -- our topic on Exercise Post-Angioplasty has numerous posts from bikers, marathon runners, etc. Prior to angioplasty (30 years ago) you would have been put on meds (which were primitive compared to today's) and told to scale your life way back. Or you might have had a bypass, which would have achieved the same result as your angioplasty, with much greater recovery needed.

And Fady -- whether a stent is right and, if so, what type (drug-eluting or bare metal) is a question you should discuss with an interventional cardiologist. Make sure you understand what medications (like Plavix) you may need afterwards and for how long. Each patient's clinical situation is different, so advice cannot be given without seeing the whole picture (and the angiogram). Are blockages like this dilated and/or stented? Sure. But the question has to be is this blockage causing you a problem? And will this treatment solve that?
Forum Editor, Angioplasty.Org, February 26, 2008

• I HAVE A 50-69% BLOCKAGE IN MY PROXIMAL DIAGONAL D1 BRANCH. MID ARE NORMAL AND IT IS A SMALL VESSEL , CAN STENT BE OK IN THIS CASE?
Fady S., California, USA, February 10, 2008

• i had a 3mm drug eluting stent placed in my almost totally blocked circumflex after a "mild heart attack". I'm 55, a 145 lb health nut and a runner (Or, I was) Now I'm reading about all the long term risks of what's inside me and the drugs I'm on for life. Will I ever run again? Also, everything I read about stents says "...helps you live a longer life.." It never says a "long life". If I'd had it explained to me before they did it, as it should have been, I'd have passed and gone just for meds. Can I live a long life now, or is this just procedure #1?
C.S., San Francisco, California, USA, January 8, 2008

• Maureen -- Hi I too am UK patient. Also I too have had 2 stents fitted to 1xRCA and 1xLAD But still have chest pain with only v moderate workload, and have tired legs after walking just small distances. I use Nitro Patches (5mg) during day and no doubt that I get relief using them. I know I could increase to 10mg per day but need to watch BP doesn't go to low But i also have atrial fibrillation which might be causing some problem on top of the artery one. However despite failing my last Treadmill Stress it is suggested that I remain on Medication, as the arteries further down the line are not too good either. So whether what is actually happening is that they wait until the drugs don't work anymore and Bypass is necessary I don't know. (I don't imagine they would say) But another drug called NICORANDIL and apparently works like nitro, have you tried that? I know its all a bit difficult, because no doubt you like me cannot get `fit` due to getting tired and exhausted before you can do any good.
TM, United Kingdom, December 1, 2007

• I HAD SURGERY LIMA TO LAD AND TEN DAYS LATER I HAD TO HAVE STENT PUT IN BECAUSE THE SURGEON OVER-STITCHED THEM AND BLOCKED THE BLOOD FLOW. HAS THIS HAPPENED TO ANYONE?
Andrew, Florida, USA, November 29, 2007

• A.C. -- curious as to what test showed the blockage? An angiogram would have not only shown the 70% blockage, but would specifically have shown whether or not there were blockages farther down the LAD (left anterior descending). Not sure why stents may not be possible because the LAD is usually one of the largest arteries in the coronary tree and stents are manufactured down to size at least 2.0mm in diameter. But the decision as to whether surgery, stents or medical therapy is the best treatment is something you need to do with your cardiologist. If you have questions, make sure they are answered. The COURAGE Trial showed that medical therapy PLUS lifestyle changes alone can achieve quite good results -- but if a patient doesn;t react well to the drugs, or has continued angina, OR is judged to be at high risk for an adverse event such as a heart attack, then a more aggressive approach may be warranted.
Forum Editor, Angioplasty.Org, October 25, 2007

• my left anterior descending artery is 70% blocked near the top and may have other blockages further down. Stents may not be possible because of artery size and bypass may not be possible because of blockage through artery. How effective is medicine in this case.
A.C., Maryland, USA, October 23, 2007

• I just had an angiogram done due to a mibi showing ischemia of the lad. They have found that my arteries are very small. I suffer from angina and can have an attack from cleaning the house or walking up a flight of stairs. Can anyone relate and give some help as I just had it done and have yet to see my cardiologist again.
L.K., British Columbia, CANADA, October 22, 2007

• Maureen -- you are not alone and there are therapies, such as anti-anginal drugs, alternatives like eecp and others. What you are describing is the subject of our interview with Dr. Robert Engler in our Angiogenesis Center. There is a clinical trial currently enrolling in the U.S. to see if angiogenetic therapy might be helpful in situations like yours.
Forum Editor, Angioplasty.Org, July 17, 2007

• I have angina and after having angiogram which was negative they have told me that its the small arteries which are causing my angina. I cannot even walk a mile and are very tired. Medication doesn't seem to do the job and have been told its called syndrome X because there is nothing they can do because its not the main arteries. I suffered from pain my my legs. Does anyone have the same problem.
Maureen, UK, July 17, 2007

• my friend had somewhat similar to your case and his doctor advised for bypass. i don't know what happened, whether the bypass surgery was indeed carried out or not.
M., USA, September 25, 2006

• Tom -- as we always ask, have you discussed this with your mother's cardiologist? Some blockages are hard to navigate to because the artery is too tortuous or twisty. Whether or not that blockage is causing a problem is something that may be told by use of a "functional" test, like a stress test, which measures not just whether there is a blockage, but whether that blockage is causing ischemia. Pain is very subjective -- there is also the possibility that a drug that has been prescribed is causing fatigue or muscle cramps (a side-effect of statins). Again, every patient is different. Your cardiologist has access to the angiograms and should be able to guide you further. Let us know what the cardiologist says.
Forum Editor, Angioplasty.Org, August 21, 2006

• My mom just recently had an angioplasty procedure performed and a coated stent inserted. She also had another artery blockage that the doctor said he could not get to. So, basically, she still has one blockage but the more pressing problem is that she cannot do much of anything without getting tired very quickly and especially her legs get tight when she tries to walk. Her knees, calves, tighten and start to ache and she can feel her heart pounding away. When she stops and rests, the ache seems to go away. She was, before the procedure, a very active woman, and I am trying to get as much information as to what can be done and whether the other blockage is causing the problems with her legs and getting tired. I have not been able to find much information about this.
Tom Ross, Houston, Texas, USA, August 20, 2006

• A news note: Medtronic just received FDA approval for a small (2.25mm - 2.75mm) bare metal stent, the Micro-Driver, made of a cobalt alloy which ostensibly makes it possible to have a stent with thinner struts, making it more flexible, without sacrificing strength.
Forum Editor, Angioplasty.Org, May 2, 2006

• Susie -- coated (or drug-eluting) stents have performed very well in narrow arteries which are at higher risk for restenosis. But placement of a stent in an area that has no plaque is not something we have heard of -- guidelines from the AHA & ACC state that interventions should not be done in vessels less than 50% blocked. That being said, we are not medical doctors and every patient's clinical picture is different -- this may be a unique situation and there may be some good reason why this is being suggested (we're assuming this was suggested by an interventional cardiologist). Ask questions why and find out to your satisfaction, get a second opinion if you're still concerned, and definitely post your findings to this Forum to help other readers.
Forum Editor, Angioplasty.Org, April 24, 2006

• A friend has had it suggested to have a coated stent implanted in a non-obstructive but narrowed area of his very small vessel off the LAD. Vessel form is congenitive and does not have any plaque. Is procedure necessary?
Susie M., Indiana, USA, April 24, 2006

• My cardiologist is keeping an eye on some small diameter DES products which he says should be on the market within 1 year. Had CABG 2 years ago. 1 of the grafts failed so they may have to stent a very narrow and long artery. Am diabetic but in good health and waiting to see what happens.
Richard Zammito, Clearwater, FL, January 29, 2006

• My cardiologist tried to stent a artery that was too small (2mm) to stent. He made a tear in my artery wall causing me to have a heart attack, while in the cath lab. Has anyone had this happen to you. Lily
Lily, Monticello, Kentucky. Wayne, January 23, 2006

• I had a balloon procedure in the branch off my RCA. Doctor said because it was too small for stents. Have you asked about the balloon procedure?
Dana S., Fremont, CA USA, December 05, 2005

• Carl: You do seem to have a problem, especially if your cardiologist is right about bypass surgery being too extreme for your condition. I previously suffered from angina symptoms (shortness of breath and pain) and ischemic heart disease and I'm much better today as a result of a FDA approved, Medicare reimbursed, non-invasive treatment, Enhanced External Counterpulsation (EECP) Officially, it's supposed to be used only when a patient is no longer a good candidate for further invasive revasularization procedures... That sounds like it might be you... But I received my EECP treatment only after studying it thoroughly and then going to a cardiologist and specifically/firmly requesting it. I was also careful to refuse an invasive angiogram because I agree with the new school of thought that believes that heart disease is most often the result of systemic vascular disease which is thought to be caused by inflammation and constriction ---- which results in many vascular lesions throughout the entire vacular system. Those lesions, in an attempt to heal, develop plaque (like a sore develops a scab) which can often be unstable. An angiogram performed with a catheter can bump a lesion which may have their plaque protruding (some do, some don't) and cause chunks of it to break free into your blood circulation and can add to your blockages worsening your symptoms and sometimes it is bad enough to have to rush a patient into heart surgery immediately. And, it happens often enough that angiograms are only performed at hospitals capable of performing emergency bypass surgeries, CABG's, etc., where you are always required to sign a release giving them permission to operate immediately if you should lose consciousness from the "a problem". 1 out of every thousand patients will die from this allegedly innoculous procedure! If your doctor has already explained this to you, pat yourself on the back. Many doctors do not. Many performed angiograms could and (IMO) have been done with the much less expensive and much safer non-invasive ultrasound procedures. Again, the patient has to ask (firmly) for these non-invasive options and be prepared to assert your patient's right to say "No" if your doctor should insist otherwise. Best advise: Go the www.vasomedical.com and learn what you can about EECP. If it makes sense to you, tell your doctor you'd like to try it. He'll most likely oblige you. It's safer than anything else I know of and it costs less than the sales tax for a bypass operation. Feel free to contact me personally at my email address: postman23_2000@yahoo.com
Gerald Oros, OrosCo Product Specialties, Collinsville, IL, November 30, 2005

• There is not much info you are providing to provide a clear answer. The worse case scenerio would be that you are covered by an HMO which owns and operates the facility and have decided they cannot provide a life extending procedure and recoup the cost. This could mean you are elderly and/or have other problems which will lead to continuous care at their expense. Of course this would be absurd, but to some, who may not understand, I am sure this thought has crossed many minds. Or, your arteries are too small, too frail, inoperable or too high a risk for either procedure, where they feel not intervening will give you a better chance to live longer. I would not assume the worse, since the doctor bothered to go in, it is most likely he is telling the truth. I know people in their 50's that have some branches completely blocked and are doing fine. Your heart will be, is, or has been providing "collaterals" to supply the portion of heart tissue that is being blocked off. I have 15 stents in my chest, and probably because my arteries and branches are pretty huge. I also have many collaterals. Excercise is probably your best bet now, but ask your doc. Good Luck.
RayZ, San Diego CA, November 28, 2005

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