Can Small Arteries Be Stented?

Current Postings on This Page (22):

• 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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