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Won't Open a 50-60% Blocked Coronary Artery (2009 archive)

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My doctor tells me they will not open the 50 to 60% artery until it exceeds 75%. Why? Wouldn't it help to open any blockage when you have one totally blocked? -- Terry T., Florida, USA

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Current Postings on This Page (82):

• I just had a cardiac cath all that was found was a minor blockage in distal circumflex. I have no pain. was given test because of arrhythmias, normal echo also.
T. Miller, Nova Scotia, Canada, December 30, 2009

• We all wish there was a pill to remove blockages in arteries, but there isn't. Statins have shown a small reduction in some patients, but it's very small. As for the Thallium stress test -- it's usually used as a pre-angiogram screening test to see if there are blockages that reduce the blood supply to the heart muscle. In your father's case, it sounds like you already know there are, so we're not sure what new information the Thallium test will show -- and there is radiation involved in that test.
Angioplasty.Org Staff, Angioplasty.Org, October 29, 2009

• My dad has had 5 Heart Attacks and has also undergone angioplasty recently which showed blocks of 60% and 75% in the same artery. Doctor suggested for stent but then he also suggested that we can take Echo Thallium Test.The other doctor said that these blocks can be medically (medicines) removed. Plz suggest.
Samuel, India, October 27, 2009

• Brandy -- did you have a stress test? And did they do a nuclear stress. This might have shown what is called "a perfusion deficit" or lack of blood supply to the heart. That together with the 60% blockage might indicate a clearer course. But you have a number of symptoms, not all of which are explained by coronary artery disease. Why do you have home oxygen? Do you have other problems. We assume you are not a smoker.
Angioplasty.Org Staff, Angioplasty.Org, September 19, 2009

• Hello. I had a heart cath on 9-17, which showed a 60% blockage in my right artery. I went to a larger hospital for a second opinion. After looking at the film, they agreed it was about 60%. While I haven't seen the doc again yet, the nurse told me that this cannot be causing my symptoms. I am a diabetic, my cholesterol has been fine but my b/p can be up and down. The first doc put me on Simvastatin and Metoprolol, I'm concerned because I have shortness of breath upon exertion (I didn't have this 9 months ago), I can sit here in the AC and sweat like a pig, which is not normal for me. Additionally, I get chest pains upon exertion or under a lot of stress. I take the Nitro as directed and it usually helps with one or two pills. Also have home O2. When delivered the lady did a test that showed the extra O2 helped my HR. I almost sleep around the clock. My legs, feet, arms and hands can go dead as I sit here & type & become ice cold with significant leg/ankle swell. I've read that all of this can be from a blocked artery. I am 33 years old and had a PE when I was 19. I feel like with all my history and symptoms medicine is not enough. Should I get a 3rd op or not worry about it? Thanks.
Brandy, Missouri, USA, September 17, 2009

• A CIMT (Carotid intima-media thickness) test can assist with cardiovascular risk prediction. The 75th percentile does not mean a 75% blockage, but it does indicate that you have "an increased CIMT", the meaning of which you should discuss with your cardiologist.
Angioplasty.Org Staff, Angioplasty.Org, September 12, 2009

• I just had a CIMT done and I was in the 75th percentile, does this mean my carotid artery is 75 percent blocked?
CGP, Kansas, USA, September 9, 2009

• Nancy -- you posted this under the topic for myocardial bridging, so we recategorized it to this topic. Are you sure he/she said a 14% blockage? How was this diagnosed? Normal guidelines are that nothing below 50% should be ballooned, stented or bypassed. Maybe there's some missing information?? Ditto to Faye. Also chelation therapy has not been proven to have benefit, although there is an ongoing trial to see if this is true.
Angioplasty.Org Staff, Angioplasty.Org, August 20, 2009

• Doctor, I am a 61-yr old female who suffers from high-blood pressure for 32 yrs, (2008) diagnosed with diabetes, osteo., and high cholestrol(all is normal, now, with meds except blood pressure--reason for CT). I had a CT last month and was advised that I have a 40% blockage in one artery-the rest are clear. Recently, I have experienced tightening in my left-upper arm and left-upper thigh followed by a cool sensation in the thigh. I have also noticed that my memory is not as good as it once was. I have an appointment with my internal doctor on Friday who said we would talk about the Ct results. Doctor, according to what I have stated, what would be your best recommendations for treating me? What do you think about EDTA chelation therapy oral infusions?
Faye, Oklahoma, USA, August 11, 2009

• I was just diagnosed with 14% blockage of the LAD and cardiologist wants me to have angiogram and possible stint [stent, ed.]. Is it common for an angiogram to be prescribed for such a small blockage? Does size of blockage matter?
Nancy, Houston, Texas, USA, August 11, 2009

• Whether or not to implant a stent is a complex decision -- cardiologists try to look at a number of issues: clinical studies on the outcomes of certain anatomical configurations, etc. -- but one important consideration is whether or not the blockage has functional significance: is it actually limiting blood flow to the heart?. Interestingly enough, just because one can see a blockage on an angiogram does not mean that the blockage is impeding blood flow or will be the cause of a heart attack. Read our coverage of the FAME study, "Better Outcomes for Stents When Fractional Flow Reserve (FFR) is Used".
Angioplasty.Org Staff, Angioplasty.Org, July 12, 2009

• I have a 50% blockage of the pIV at the back of the heart. One cardiologist says they will absolutely not stent it and another group at the hospital where the angioplasty was done recommended it. What is your opinion?
Peggy K., Ontario, Canada, July 12, 2009

• J. Reagan -- it's very important to take the proper medications, especially Plavix and aspirin, post-stenting. Check out our topic on "Financial Assistance for Plavix and Other Prescription Drugs" and some of the information may help you find help. Meanwhile, perhaps your cardiologist has some samples to tide you over.
Angioplasty.Org Staff, Angioplasty.Org, July 12, 2009

• I am a 54 year old female and had a massive heart attack Sept 30th, 8 months ago. I had two stents in my LAD and now these stents are 50-70% narrowed, and I have another blockage in the LAD above the stents. Am I at risk for another heart attack? Because I have no money or insurance I take no medications for this condition.
J. Reagan, Plano, Texas, USA, July 12, 2009

• My mom has a heart defect. She has no left coronary artery and no circumflex artery. She has 4 blocked arteries that are coming from the Manin right coronary artery. Blockage is 90% on one, 70%, 30%, and 40%. They say they are too small to unblock. Her heart pills are not working for her. She can barely do housework. Her heart pills are, Metoprolol Tartrate, Ramipril, Lipitor. Is there anyone out there that knows of how to help her not to have a heart attack and die? The doctors say they cannot help her anymore. This is in Canada. Is there any US doctors that know anything? Please help!!! Her daughter.
Carla S., Milford, Massachusetts, USA, February 13, 2009

• Ivia -- check out the Forum Topic, "Can A Total Occlusion Be Stented?" Has he been seen by an interventional cardiologist who does chronic total occlusions? (a.k.a. a CTO). The decision NOT to do such a blockage is often because he may have developed collaterals, small arteries that provide some circulation and opening a very old blockage can sometimes do more harm than good. Miami has a number of excellent Heart and Vascular Centers, Miami Baptist, etc.
Angioplasty.Org Staff, Angioplasty.Org, February 7, 2009

• My dad is 69 years old has had two heart attacks and two strokes. He has emphysema and has a feeding tube. His left coronary artery is 100% blocked. Can anything be done. Two doctors have advised us that nothing can be done. Why is this?
Ivia, Miami, Florida, USA, February 7, 2009

• Just came home from the hospital, ekg at Dr. office did not look good. cardiologist did it again still looked bad. did angiogram. left coronary artery80% blocked)(LAD and LD was 70% blocked(LCS 30%, LCS a little lower down the LCD was 40% blocked and as you go down further it branches down and right before the LAD at the bottom and the the LAD at the top is a artery called LCD which is blocked 50% ad he LCD right beside that one was clear. The best he could do was put a Xience V Everolimus Eluting Coronary Stent System in the 80% LCA CX. I am shorter of breath now than before but for five days they wanted me to do nothing so I'm guessing sleeping so much is probably the breathing problem. I don't go back for one month and its scary not knowing if it stayed in place. My mother had double bypass at 31 years old at Duke University in Raleigh, N.C. and my half brother died at 34 of a massive heart attack coming into home base. my sister inherited the gene and one other brother got it. my two children,my daughter no and my son yes he got it. 11 years ago by angiogram i was told the main right iliac artery going to my legs was greater than 50% closed but on the right they did not see anything. is it possible they did not look on the right side and just looked on the left. he said bypass would have to fix the rest in a couple of years. how am i suppose to be feeling with this stent, because i do not feel any better or different in the pressure or chest arrhythmias
Evelyn, owner of business, Jacksonville, North Carolina, USA, January 24, 2009

• Pravin -- the question is "are you symptomatic?". That is to say, are you having chest pain, angina, etc. that is limiting your ability to function? The major question is whether to revascularize (angioplasty or bypass surgery) or to stay with OMT (Optimal Medical Therapy) which involves medications, but also lifestyle changes like exercise, smoking cessation, etc. Chelation therapy has not been validated although there is an ongoing trial. But there is no evidence that chelation therapy has any benefit. EECP is an option if other therapies have not yielded symptomatic relief.
Angioplasty.Org Staff, Angioplasty.Org, December 18, 2008

• I had a CT Scan of coronary arteries and they found 70% + blockage in LAD Coronary artery. My cardiologist is talking about angioplasty and possible stent placement. I read about Chelation therapy for the blockage and also EECP treatment for this condition and I am confused which treatment I should go for.
Pravin P., West Des Moines , Iowa, USA, December 18, 2008

• Jo -- check out our topic on Peripheral Angioplasty, since your blockage is in the leg, not the heart. When you say "surgery" we are not clear -- are you having a surgical procedure or an interventional (balloon, stent, etc.) procedure?
Angioplasty.Org Staff, Angioplasty.Org, December 18, 2008

• I recently had an angiogram and a blockage of 60% in my right femoral artery. It cannot be stented as it would interfere with the arterial hinge. What is this surgery called and just exactly what is done in the procedure. It is not available in my home town and I will have to go to St. Louis for the surgery. I am a 76 year old female. I have other stenting, right coronary artery 100% blocked but I have a lot of collateral veins. I am very concerned about what my Dr. calls a "complex procedure". What information are you able to give me? Thanks.
Jo C., Springfield, Missouri, USA, December 18, 2008

• Thanks!
Angioplasty.Org Staff, Angioplasty.Org, December 6, 2008

• Just want to thank you for an informative site that does not go over-board with ads and advice.
F.B., Nova Scotia, Canada, December 6, 2008

• MC -- 49% is just below what is considered within the guidelines for treating (that's 50%). 49% is pretty precise -- how was this figure arrived at? Did your father have an invasive angiogram?? In any case, we can't give needs to stop smoking. Smoking is a very significant cause of heart disease. It is certainly hard to stop -- it is, after all, a physical addiction. But there are clinics and support groups around. Perhaps your doctor can help him here with prescription meds, paches, etc. It is possible that, if he can stop, and lower his other risk factors, he might not need surgery, angioplasty, etc. -- at least for now. See if you can help him.
Angioplasty.Org Staff, Angioplasty.Org, November 20, 2008

• Hello, my father has the choice to have an elective bypass surgery. The doctor told him he has 49% blockage. He had a stent put in on the other side of his heart and has not been the same. They say he will need to choose to have surgery in the next 3-6 months. He is a big time smoker and is having a hard time stopping. Does anyone have any advice if he should choose the surgery or not?
MC, California, USA, November 12, 2008

• Teri -- have you discussed a CT angiogram with your doctor to see non-invasively if there are significant blockages?
Angioplasty.Org Staff, Angioplasty.Org, October 30, 2008

• My name is Teri, I am a 47 y.o woman who had a 90% blocked LAD in May 07 which in turn caused emergency open heart surgery on pump in which the Surgeon used a dacron patch after cleaning out the blockage. 3 mos later below the dacron patch was blocked again below the patch which in turn a 2nd open heart surgery was done and a bypass using my mammary artery to bypass the LAD, this was in Aug. 07. I also have several stenoses(s) on the right side ranging from 50-70% - my concern is this... I have been having symptoms of chest pain, cough, headaches, low back pain, heart palps shortness of breath, right shoulder pain, fatigue no appetite and sharp pain on occasion under my right rib cage. I am constantly stressed and filled with anxiety "waiting for the other foot to drop" as far as the other stenosis, my cardiologist just performed a stress treadmill test and nothing showed anything to concern her at this point, she will continue my meds and watch the other stenosis(s), I am very un-comfortable and feel that being as my surgeon told me that my CAD had developed over the past 3 years and I don' quite understand why my cardiologist would not do an angiogram to rule out any other trouble with the 50-70% blockages. Your input would be greatly appreciated.
Teri, San Carlos, California, USA, October 22, 2008

• By main trunk, we assume you mean the "left main"? Left main disease definitely occurs. Stenting a left main has been controversial, although studies just presented show, in certain cases, that it can yield a good result. Ideally these are decisions best made with both your interventional cardiologist and a cardiac surgeon, which is what sounds like is happening. Most importantly is for you all to understand the differences, why a recommendation is being made for one or another treatment, and what the post-procedural reality is. Angioplasty and stenting are successful techniques, but so is bypass surgery -- the key is applying the appropriate therapy for the appropriate situation.
Angioplasty.Org Staff, Angioplasty.Org, October 21, 2008

• My husband, 51 has been having some light chest pains. Had a dye test in the cath lab. Doctor said the main trunk artery is 60% blocked and the right coronary artery is 80 % blocked. Also, said his heart's pumping strength is 35%. We are scheduled to meet with another doctor in 2 days to discuss bypass surgery. A lot of his family have had heart problems. Doctor said the main trunk artery would be too dangerous to put a stent, so that is why they are saying bypass. I thought he said it is rare for the main trunk artery to be blocked. What is your thought. Thank you.
JKS, Louisiana, USA, October 17, 2008

• Jimmy -- You're welcome. The decision about whether or not a stent is indicated is definitely something that can only be made by you and your cardiologist. There are two main considerations. One, is the blockage causing angina that is not relieved by medication, lifestyle changes, etc. (a.k.a. "optimal medical therapy")? Two, is the narrowing severe enough to be worrisome, for example, will it provide a site for platelets to collect, form thrombus, and cause an infarct (heart attack). Much of this decision also rests on the patient's clinical picture -- it's not just a simple "if it's greater than 70% or 75% we stent" decision. So we always recommend that you discuss these issues with your cardiologist -- so you are prepared for and understand the purpose and reason for whatever therapy he/she thinks is best.
Angioplasty.Org Staff, Angioplasty.Org, September 15, 2008

• Thank you for your response, it was very helpful. We just went to the cardiologist last Friday, he went through everything and said the only way to see what is going on is to do a cath. He said the CT scan is only as good as the reader of it (it was done at a different facility then he uses). He said that he would like to do a cath to see what percent the blockage was. We asked at what point does he do a stent, we would prefer that to be our last resort, we would like to try other means such as medications and diet changes, are doctors pretty careful about putting a stent in after a certain percentage. He told us 75% or that point we would probably want a stent is that correct? I am more concerned about putting a stent in without having a chance to try diet. Any input would be appreciated. Thank you again.
Jimmy, Dade City, Florida, USA, September 15, 2008

• Jimmy -- CT angiograms are very accurate in ruling out coronary artery disease (CAD)-- a bit less accurate when showing positive results, and definitely less accurate when dealing with a calcified lesion (the calcium blocks the image). Your question is a very good one and one that is being debated in the cardiology profession. You have a narrowing, but can it be managed with medication, diet, exercise, etc? Only your cardiologist, who has your records in hand, can really help you make this decision. The COURAGE trial showed that optimal medical therapy can be very successful -- it really depends on whether or not the blockage/lesion is significant (greater than 70%) and if it is flow-limiting. But with modern medications, it's seems to be fine to start with medical therapy -- it's always possible to switch over to interventional (angioplasty, etc.) at a later date.
Angioplasty.Org Staff, Angioplasty.Org, September 12, 2008

• I'm a 44 year old male, very physically active not overweight, and a non smoker. I had some slight chest pains and thought it may be due to lack of stretching. I mentioned this to my dr. and he recommended a stress test. The test came back abnormal so they recommended a CT Coronary Arteriogram. The report read that all arteries showed to be normal except the LAD, it demonstrates calcified plaque at the medial portion producing moderate to severe stenosis. This calcified artery plague is identified after the origin of the first diagonal artery. Left Circumflex showed that the origin of it from the left main coronary is normal. The artery is small. The visualized portion of the obtuse marginal are normal.

Summary said: Presence of mild stenosis involving middle third of LAD produced by a calcified plaque. The left circumflex artery and right corollary artery fail to demonstrate significant areas of stenosis. Calcium score is 35 agatston, related to calcified plaque identified at the medial portion of the LAD. Satisfactory cardiac motion. Ejection fraction corresponds to 58%. We are scheduled to see a cardiologist this week...the doctor that did the CT was not very this the widow maker? Does this show what percentage the artery is blocked? At what percentage do they typically recommend a stent. I would rather try changing my lifestyle and medication prior to having a stent. My pain is more like tightening in the chest, but only at rest, when working, I work outside with manuel labor and never feel it then, nor when exercising. Any questions answered would be appreciated. Thanks.
Jimmy, Dade City, Florida, USA, September 7, 2008

• R.L.-- Option 1 is really more than "doing nothing". It may mean no immediate revascularization, but all three options should really include things your dad needs to do to reduce his risk factors. Lose weight, moderate his drinking and get on medications to reduce his cholesterol, BP, if needed, etc. The automatic grafts you mention are called collaterals, smaller vessels that the body creates (amazing bodies we have!) to compensate for some of the blood flow being blocked. We don't give out medical advice, for example, whether he should fly to Canada or not. India, of course, has excellent cardiologists who can perform angioplasty. But these types of decisions should be made together with an interventional cardiologist and the patient/patient's family, as to what risk there is, what outcomes can be expected, etc. Obviously you don't want that 80% blocked Right Coronary Artery (RCA) to progress to further closure.
Angioplasty.Org Staff, Angioplasty.Org, August 3, 2008

• The doctor told my dad his right artery is 80% blocked and one of the sub branches is 90% blocked. He said that the left artery is not functioning anymore (its been about 6 months to a year and they say he had a heart attack then - I have no idea how we did not know). He was complaining about chest pains and said he had trouble walking but thought it was due to this thighs (this right thigh hurts a lot when her walks). The good news according to the doctor is that his right artery is very big and pumps more blood and the heart has automatically made grafts. 3 options were suggested: 1) Do nothing (we don't favour this one) 2) Angioplasty (the doctor said it can take care of 80% of this problem) 3) bypass surgery and do graft (we are against this option) My dad is in india right now but wanted to travel to canada to get this done. Is it fine to travel? Also how long can he stall his angioplasty process (he has been stalling this but we want him to get it done in india next week itself) He is 54, obese, loves food, non-smoker and drinker. He has been diagnosed with high cholesterol (of course). Please let me know how dangerous his situation is and how long can he wait to get this done and also if he should even travel for the procedure. from a very concerned daughter.
R.L., Canada, July 28, 2008

• Sai -- your Calcium score of 68 is relatively low. It is one of several risk factors. Family history is certainly another. Your CT angio isn't as accurate as an invasive angio, but it's pretty good and a blockage of 30-40% is something to be watched, but is not in most guidelines recommended for revascularization (angioplasty or surgery). Do you have any symptoms of CAD? What does your cardiologist say? Sounds like you are at an early stage, which may or may not progress, but reducing risk factors is certainly prudent.
Angioplasty.Org Staff, Angioplasty.Org, July 13, 2008

• I'm 32 yrs old. Had a routine 64 slice Ct due to Family history of heart disease, Father died at 56 from an MI. CT angio showed a 30-40 percent plaque in mid LAD.Calcium score was 68. What I do I do for treatment? Started aspirin, statin. Please let me know. ASAP
Sai, India, July 10, 2008

• Jav -- angioplasty/stenting is certainly indicated in a 90% lesion (narrowing) but this may depend on the results of your other tests as well. What doid the cardiologist who did your angiogram recommend??
Angioplasty.Org Staff, Angioplasty.Org, April 27, 2008

• I'm a 55 years old man and i've done coronary angiography which showed a 90% blockage in RCA. I WANNA ask what should i do, medication can be beneficial or angioplasty????
Jav, Pakistan, April 22, 2008

• Sandy -- anything under 50% is considered not significant and interventions, such as stents, are not recommended. The 70% narrowing might be stent-worthy, but the important questions are: is this 70% narrowing causing a reduced blood flow to the heart?; is it causing symptoms, such as anginal pain; is it limiting activity? The COURAGE trial demonstrated that stable low risk patients can do as well on "optimal medical therapy" as they can on stents. This means compliance with medications and lifestyle changes (diet, exercise, smoking cessation). If you have questions about the 70% lesion, consult an interventional cardiologist -- make sure he/she has the angiograms that were done and all other test results as well. It is also possible to gauge the progress of coronary artery disease using other tests, such as a multislice CT angiogram, which is non-invasive and takes only a few minutes.
Angioplasty.Org Staff, Angioplasty.Org, April 21, 2008

• Mom had angioplasty done two days ago. Three blockages. 1=20%, 1=30% and 1=70%. The Doctor did not fix this, I heard that hospital was not licensed for that procedure. Should she get this 70% done. Which means going through this procedure again. Concerned Daughter. Please e-mail me back with an answer. thanks.
Sandy P., New Jersey, USA, April 9, 2008

• I have 80% blockage in RCA. Would I need to undergo Angioplasty or stenting or can medication cure it?
Pankaj, India, February 15, 2008

• Angela -- most cardiologists recommend trying optimal medical therapy as a first line to treat angina. This includes not only medication, but diet, exercise, obviously smoking cessation (but we would assume that you don't). These were the results of last March's COURAGE trial. But if that doesn't relieve angina, angioplasty is sometimes indicated. 50% is considered the borderline for this, but each patient's clinical situation is different, so this is a discussion you should have with your interventional cardiologist (the specialist who does angioplasty) and a decision you can jointly make after discussing the pros and cons. Let us know how things go.
Angioplasty.Org Staff, Angioplasty.Org, February 13, 2008

• I am a now 48 yr old female who had angina in May of 2001, MI in June of 2001, and CABG in 2003. I returned to the cardiologist with some slight chest and arm pain, and lot of leg cramps. A cardiac cath was performed which shows mid lad 50% blocked. I am already on Plavix, aspirin and Toprol. What is the usual treatment for my 50% blockage?
Angela B., Indiana, USA, February 7, 2008

• Donna C. -- we do not give patients specific diagnostic advice (and nothing on our site should be a substitute for advice from a medical professional), but we can say that your various tests put you in what is called the "indeterminate" category (as if you hadn't figured that out already...). Nuclear stress tests show whether the heart is getting enough oxygen via the blood. As you have experienced, they are sometimes inaccurate -- this seems to occur more in women. A CT Angiogram (CTA) gives a direct view of the artery, and yours showed a blockage in the indeterminate category. CTA is an extremely accurate test in ruling out coronary artery disease; it is still good, but somewhat less accurate in determining blockages in this mid-range of 40-70% and much of this accuracy depends on the equipment used and the skill of the intepretation. Have you had a consult with an interventional cardiologist (the specialist who does angioplasty)? One question (which you've correctly raised) is whether or not you should be having nuclear stress test followups, or perhaps a followup CTA or cardiac catheterization at some point. You don't want to be rushed into a procedure that may not be necessary, but you also want some peace of mind. For more about these tests, check out our section on "Imaging and Diagnosis".
Angioplasty.Org Staff, Angioplasty.Org, February 7, 2008

• I am a 51 year old female. In November my Asthma Dr. said that my heart was not in rhythm and was skipping beats. I went to my P.C. Physician the next day and he said it sounded fine to him and I left. At the end of December, I had severe chest pains which radiated up to my jaw, down my arm, sweating and then extreme heaviness in my chest. EMS was called, blood pressure 186\108 but said that my EKG was fine and did not transport. They asked me to follow up with my primary physician. I did and he ran another EKG and it showed that I had a heart attack on the left side of my heart. I had a nuclear stress test and nothing showed up and the cardiologist said I was free to go, my heart was in perfect condition. However, I was still having pain so requested another test and my P.C. Physician schedule a 64 slice CT Scan. I got the results last week and it showed that my LAD 6, the widow maker artery, was 60% blocked and one other that branched off of that 40% and on the right side one that was 35%. Since I was still having pains he gave me nitro spray to take. He said the Cardiologist said he would follow up once a year with a Thallium Stress Test. If the stress test didn't show anything wrong the first time, why would he perform it again in a year? That was it, no instructions on diet, what I could and could not do, said I had my 60,000 mile checkup and see ya. After reading on here from others why they don't do any type of stents or open heart for anything less than 70%, I understand that because of the risk. However, I don't know where this pain is coming from and some feel like a heart attack is fixing to happen again. I do have high blood pressure, asthma and high cholesterol and on Vytorin for that and Toprol for the high blood pressure. I don't understand why the Cardiologist hasn't tried to figure out where this pain is coming from or is it just Angina? My Granddad died at age 55 of CHF, my Dad at age 55 of CHF and my brother has had a heart attack and has CHF, as well as my 29 year old nephew.
Donna C., Isle of Palms, South Carolina, USA, February 4, 2008

• Paula -- a second bypass surgery and EECP therapy are the two ends of the therapy spectrum. EECP has been shown to help angina in some patients. Have you consulted with an interventional cardiologist. This is the specialist who performs angioplasty and may be able to give you a prognosis on whether or not he/she can open your blocked artery without another bypass. These are complex questions that should be discussed with your cardiologist.
Angioplasty.Org Staff, Angioplasty.Org, February 4, 2008

• I am a 51 yr old female who has a history of a double bypass 7 years ago. I recently have had frequent angina with SOB and exertion. A recent coronary cath revealed a 100% blockage of the RCA. The doctor initially maxed me out on medication, then suggested bypassing the bypass that is now blocked. But now is suggesting EECP. I am confused, what is usually done? And will I eventually need bypass anyway?
Paula, Madera, California, USA, January 11, 2008

• I just had a heart cath and have a 50-60% blockage of the circumflex artery of the left coronary artery; a 40% blockage of the left coronary artery; a stent in the LAD; and a blockage of 30% of the LAD further down below the stent. I also have one more blockage of the circumflex artery. How does this look for me?
Donna S, Baltimore, Maryland, USA, December 22, 2007

• My doctored did angioplasty on LAD having 50 % blockage . I was having the symptoms of uneasiness and minor problems in the stress thallium test. But since after angioplasty I am having new problems of pain in left arm and shortness of breath . Can any doctor suggest the diagnosis.
Sunsing, India, October 5, 2007

• Right cartoid artery 50-69 stenosis,ultasound mri angiography 50% stenosis. Had 5 way by-pass12-2003,diabetic,high blood pressure,obesity 58 year old male. I have been treated with aspirin, plavix,blood pressure medications and diuretics. Cardilogist recommended continue with medication. I also was just treated for diastolic dysfunction and heart failure. I am having a surgery consultation to learn more about condition.
FJV, West Virginia, USA, October 2, 2007

• I am a 57y.o. female with a history of 2 TIA's in June, severe protruding atheromas in the aortic arch, moderate disease in the descending aorta, and high cholesterol. I was placed on Plavix 75mg, Lipitor 80mg and 82mg aspirin. I am also under treatment for PMR and am on a Medrol taper, currently 10mg. I wore an event monitor for a month; the dx was atrial fibrillation. The cardiologist said nothing further was indicated, however after a hospitalization which included a cardio consul, it was strongly advised to have a stress test. The new cardiologist found abnormalities in the thallium stress test. I had an angiogram , and it was discovered I had 70% blockage of the LCF, which was repaired with a DES, and 100% blockage of the RCA. The interventional cardiologist told me it was too dangerous to try to repair the RCA at that time due to the amount of dye already used and what would be needed for the second repair, and I would need to return for the second procedure in a month. He also told me that there were collateral arteries which had grown off of the RCA. When I saw my cardiologist the following week, I asked him why I even needed this second procedure if there were new arteries that had formed. He told me that the "old way" of thinking was to leave these blockages alone, but that over the past few years cardiologists had changed their approach and the proper course of treatment was to open them. The cardio who did the procedure told me this one would be difficult and long and he would have to place catheters in both the right and left femoral arteries. My feeling is of course he wants to do this procedure; it's his job and it's challenging. However, if it cannot be successfully opened, nothing further would be attempted, so is it worth the risks?
Lynda A., New York, USA, August 25, 2007

• Michael -- guidelines from the AHA/ACC/SCAI state that there is little reason to treat blockages below 50% with angioplasty. Your treatment would most likely be reduction of any risk factors (smoking, etc.) and other lifestyle changes, along with meds to control your disease. But any treatment should be prescribed by your cardiologist! We're sure that he/she will also follow up with you in the future to make sure the blockage hasn't progressed.
Angioplasty.Org Staff, Angioplasty.Org, August 10, 2007

• I have 40% blockage in the left ostium. Please advise as to treatment.
Michael P., North Carolina, USA, August 1, 2007

• Sharon -- are the 30-45% blocked arteries in the coronary? Strokes are caused by, among other things, blocked carotid arteries (sometimes known as neck arteries). A blocked coronary can cause angina, possibly a heart attack -- although your blockages are below what would be considered significant. What test showed this blockage?
Angioplasty.Org Staff, Angioplasty.Org, July 22, 2007

• I just found out that my right arteries are 30-45% blocked. I really worried about strokes. Because both my parents and just in January of this year my sister died of stroke at age 57. I'm worried about that will these blocked arteries cause a stroke. I'm age 47.
Sharon S., New York, USA, July 19, 2007

• M.L. -- less than 50% blockages are not usually dilated (opened up with angioplasty) -- but the important fact is not necessarily the percent blockage, but whether the blockage is "flow-obstructing" or whether the plaque is what is sometimes referred to as "vulnerable" -- that is, not necessarily a large blockage, but one that contains lipid-rich material that might rupture, causing a heart attack. Currently, both of these characteristics can be measured, to some extent, using several procedures like IVUS or FFR (read about these in our IVUS Center). If you're concerned about early death due to blockage (which would be a heart attack) check out the hospitals in your mother's locale -- find the one that has the best "door-to-balloon" times for emergency angioplasty. A very important fact lost in much of the news items is that angioplasty, performed within 90-120 minutes from onset of heart attack symptoms, can stop the heart attack in its tracks and preserve the heart muscle.
Angioplasty.Org Staff, Angioplasty.Org, July 17, 2007

• My mom just had an angiogram and they told her that she had a 50 percent blockage in her main artery and a 30 percent in another one. My family is prone to early death because of blockage. What should I tell the Doctor??
M.L., California, USA, July 16, 2007

• Wil -- not taking Plavix and aspirin after implantation with a drug-eluting stent is definitely not recommended. Just read any of the many articles on this site -- the main risk factor for late stent thrombosis is non-compliance with aspirin/Plavix. There is no data to suggest that aspirin has a negative effect on healing -- it's main function is to keep platelets from gathering together and forming a clot. And Gary, 50% blockage is a very grey area. Most cardiologists probably would agree with yours. The question is whether the blockage has a functional effect -- i.e. is it stopping blood flow, causing ischemia to the heart muscle or putting you at risk for a heart attack. Each case has to be evaluated individually. For example, a 50% blockage in a alrge vessel probably isn't having a great effect, where a 50% blockage in a narrow one might.
Angioplasty.Org Staff, Angioplasty.Org, January 7, 2007

• On 20040410 I had a 100% blockage in the mid LAD coronary artery. After 3 hours, a drug-eluting stent was placed. For 6 months I have taken aspirin and Plavix. In sept 2004 I felt more and more out breathing. On 17 nov the cardiologist found a 90% blockage at the edge of the stent(caused by connective tissue). He placed a second stent in front of the old one to open it. The cardiologist prescribed again ascal(aspirin) and Plavix for 6 month. But I had a thought of "Deja Vu" and decided to take no "medicine" at all. At 5 dec 2005 the cardiologist found both stent 100 % open but I had another blockage 70% in an other branch. He won't give me a new stent because I had no damage of it (He said) and because of the trouble I had had with the first stent. I had not agreed I think that the use of aspirin after stent placing prevents the natural healing of the arterial wall when it has a little damage by placing a stent. I think that there is no scientific research about the influence of aspirin on damaged tissue in the coronary artery. It is even possible that in some cases the "wonder medicine" Plavix repairs the damage of the use of aspirin. My cardiologist ( a professor) called me a fantasist. Am I? (ps. I am a biologist)
Wil van B., The Netherlands, December 28, 2006

• Jan,06 had 4 stents/right side because of angina, afterwards everything was great, BP-120/80, great blood work results, lost weight/great cardio workout. Sept.30, mild heart attack. Another stent on right side, doctor said that I had 50% blockage on left side. I worry that I might have inflamed soft vulnerable plaque, and another rupture could happen. I am 56, in great shape, but worried, my doctor said that he normally wouldn't do a stent on the 50% blockage, said it is up to me, would do you suggest, thanks
Gary Franz, Fresno, California, USA, November 16, 2006

• Pratul -- wow! Climbing in the Himalayas with a 100% blockage in the Right Coronary Artery? Either the tests are from the man down the hallway, or your left coronary arteries are in great shape. You did say that, and it's true that some people have a very dominant left or right system, which must be the case here. A 100% blockage is also called a Chronic Total Occlusion (CTO) if you have had it for some time. How best (or even if) to open these vessels is a big topic in interventional cardiology right now and the subject of many presentations and discussions at the major heart meetings. There also are new devices on the market, specifically designed for these cases. There are many technical challenges with CTOs -- not the least of which is that, since the contrast dye can't pass through the blockage, it's hard for the cardiologist to see where to safely push the guide wire for the balloon. A wrong turn and he's dissected the artery wall. Think of driving your automobile through a tunnel while blindfolded. As for reversing coronary artery disease, Dean Ornish has indeed published studies showing a small reversal in arterial plaque under his diet, exercise and meditation plan. At the last American College of Cardiology meeting, Steve Nissen MD of Cleveland Clinic also showed a study in which heavy statin dosages reversed plaque. But these are just the beginnings and the reversals are not massive -- but they do show a direction for more research. As for your CTO, you might want to consult with interventional cardiologists, as well as surgeons, who are experienced in doing total occlusions (practice makes perfect) and get their opinions before making a decision.
Angioplasty.Org Staff, Angioplasty.Org, October 4, 2006

• I am 44 yrs old and had a positive stress test a year and a half ago for an insurance policy that I had to take. A second stress test was taken in feb'06 which was also positive. A coronary angiogram was done on 2nd Sep where it was found that there is a 100% block in the RCA while the two left arteries were completely open. I am advised angioplasty. After the angiogram I have done a 40 km trek in the Himalayas at 10000 ft height up to 14600 ft (stayed overnight at this height) over 4 days and did not feel much discomfort. I have been doing yoga and pranayam for the last 7 yrs and intermittent walking (average of 2-3 days in a week ). I have just purchased the book of Dean Ornish on reversal of heart diseases and wonder if this is really possible, since my doctor says reversal is impossible and that Angioplasty is the only remedy for opening the blockage. And that at best such alternative therapies can only stall the blockage. My question is Can Angioplasty be done on fully blocked arteries ? If so, how long can I wait before I do the angioplasty ? Is it a fact that after a certain period lapses say 6-12 months, Angioplasty may not be doable and the option left would be only a bypass ? I wish to explore alternatives without jeopardizing my chances of getting the Angioplasty done ? I am ready to adopt lifestyle changes as suggested. Please suggest /. advise course of action.
Pratul Dalal, Mumbai, India, September 18, 2006

Ian from Chicago - read the excellent response from the editor. You only need a stent in the RCA if you have SYMPTOMS of angina NOT controlled by medication. putting a stent in will not make you live longer and not reduce risk of future cardiac events (it may actually increase those risks!)
Dr Mo Samuels, cardiology resident, University of London, UK, cardiology resident ( on Sunday, September 17, 2006

• Jack, 50-60% is not necessarily "obstructive", but given your concern, you're doing the right things. We would add to check your blood pressure and cholesterol levels on a regular basis and treat any abnormal findings. But exercising, diet and not smoking are key factors. We just attended a Heart Health Symposium presented by cardiologists at New York's Cornell Medical Center and they were emphasizing that family history is not really as great of a risk factor as is, for example, smoking, etc., because the genetic or environmental tendency towards the other risk factors can be controlled, as you are doing naturally by "being healthy", and, if there is high blood pressure, etc., thoses factors can also be controlled through modern pharmaceuticals.
Angioplasty.Org Staff, Angioplasty.Org, September 16, 2006

• My brother died at 38 years old not from heart disease. The autopsy reported a couple of his arteries were 50-60% blocked. I am his brother 5 years younger and am concerned. Two questions: is 38 male common or uncommon to have 50-60% blockage it seems young. And, besides diet, exercise, and not smoking, is there anything I should do to prevent this from happening to me? Thanks, Ray.
Jack, California, USA, September 12, 2006

• I suspect it's an individual judgment call, Terry. I had a ~50% blockage in the CX artery and my cardiologist chose to stent it. Like the forum editor noted, the fact your RCA was 100& blocked sounds like the reason.
Kevin, Albuquerque, New Mexico, August 4, 2006

• Because a 50-60% lesion without haziness on the angiogram is not flow-limiting. Sometimes a lesion that is only 30% is significantly hazy on the angiogram and it indicates soft plaque and can be stented. The other thing to remember is stenting treats angina; it doesn't prolong your life. If you have a lesion that does not appear to limit blood flow, then why stent it? If something goes wrong during the procedure, your life could end in a matter of a few minutes while on the table, and there was no obvious indication to stent the lesion to begin with.
francis, north carolina, USA, July 26, 2006

• Carol -- as we mentioned below, there are guidelines reached by the major professional organizations. You can read the most recent update of this document, titled "ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention—Summary Article" in PDF format. It's 20 pages (and that's just the summary) and relatively complicated for a lay audience. Suffice it to say that the decision as to what should be treated by revascularizing (i.e. angioplasty with or without stenting, or bypass surgery) and what should be treated with medications and lifestyle changes really depends on the specific clinical situation. It's not a hard and fast "this artery is 70%, so open it -- this one is 65%, so leave it alone". It depends of the state of the other coronary arteries, the patient's clinical situation and other health factors. It's a complex question. The new guidelines actually outline circumstances where a 50% stenosis might be dilated -- and actually they don't state categorically that anything under 70% should be left alone (we amend our previous post) -- because they are allowing cardiologists the leeway to make those judgements.
Angioplasty.Org Staff, Angioplasty.Org, July 22, 2006

• Is there any one place which sets out the guidelines regarding the size at which an artery should be surgically opened and when they should be treated with medication? Is there some AMA standard, or is it set more by insurance companies, or the local hospital. I've heard different sizes by different cardiologists, but each claims that "standards" require_____ size. Who are we to believe?
Carol, Atlanta area, Georgia, USA, July 21, 2006

• The subject of why cardiologists tend not to dilate (open up) and stent arteries less than 70% is understandably a tense one for patients. The patient sees the angiogram, sees the blockage, but their doctor doesn't want to treat them with a stent. We'll talk about that, but first off, a quick disclaimer: as we always state, do not take anything on this site as "medical advice" -- we try to provide information to help you talk more productively and efficiently with your doctor. One patient's clinical situation can be very different from another's, and lead to very different therapies for seemingly similar problems.

As we say on our page about coronary artery disease, "Angioplasty and bypass are mechanical 'fixes' to what is essentially a biological problem." And they are the most invasive fixes -- hence the guidelines from the AHA/ACC not to treat blockages < 70%. As with all medical procedures, there are risk factors associated with each type of intervention. Through the creation of evidence-based "best practice guidelines", professional organizations like the American College of Cardiology (ACC), Society for Cardiovascular Angiography and Interventions (SCAI) and the American Heart Association (AHA) have determined various thresholds for treatment. It's not so much that the patient isn't eligible below the threshold, but that the treatment just doesn't do all that much, and is not worth the risk, even if that risk is small. In other words, instead of regretting that you can't be stented because your blockage isn't big enough, it's actually good news: it's not big enough! There are other treatments -- there are a range of pharmaceuticals that can mediate symptoms and, as recently shown at this year's ACC meeting, statins can actually reverse plaque build-up. Lifestyle changes (smoking, diet, etc.) are all critical. Dr. Dean Ornish has shown reversal of symptoms of coronary artery disease (and even some lessening of plaque) through his program of diet, meditation, etc. Obviously, any blockage is a sign that you need to be monitored over time -- there are newer less-invasive tests, like multislice CT angiography that can make this easy and quick.

Finally, because we are all so visually-oriented, we may put too much emphasis on the appearance of the blockage on a two-dimensional angiogram. But what is the actual effect of that blockage? So-called "functional tests", like Thallium Stress Tests, can measure if these blockages are actually reducing blood/oxygen to the heart muscle -- they may not be. Also there is much research being done right now that seems to indicate some plaques are more "vulnerable" than others -- more prone to rupturing and sending lipids into the bloodstream, causing thrombus (clot) and a heart attack. It may not be the size of the plaque, but the tissue characteristics, that are important.

So getting the news that you have a blockage that's too small to stent unless it gets bigger means you have other options. And that's good news.
Angioplasty.Org Staff, Angioplasty.Org, July 19, 2006

• I understand this is an old topic, date-wise that is, but my questions fall under its category and I guess I'm just reaching out for some answers tonight. I'm a 28 year old male who recently had stent put in due to 100% blockage of the LCA. Not to point out the obvious but 28 is rather young. Having said that and confirming that the age is not a typo I feel I should give you quick background about myself so you can hopefully help me to the best of your abilities...The stats; 5'10"...180 pounds...smoker, was for about a decade, athletic, and truth be told I love things like pizza and wings as most do, but I don't think I ever indulged more than any one else my age. Family history...Lots of heart attacks on both sides. Now that we've covered the history I'm concerned about the future. I have questions....While I understand you can't give medical advice hopefully you can help to point me in the right direction. My RCA is now 60% blocked. My cardiologist doesn't think it's time to do a second stent. I understand we only use roughly 30-40% of our arteries capacity but why wait? How many opinions should I get? I guess I'm a little, well concerned would be understatement, but I just want to be able to live my life and not worry that every time my heart rate every time it gets elevated. I want the peace of mind that both arteries are up and ready to go. My friends and I still play basketball and volleyball and football and drunken whiffleball, it's a good game.... I just want to know, as much as possible at least, what the future holds. I've asked my doctors point blank before and they seem to dance around the issue with reassurances. I don't want it to seem like I'm looking for the worst case answers, but in a sense I want to know. I need to know what the stats are. How long will this stent last? 20 years may be great for someone in their 50's, but where does that leave me? I know I've thrown a lot out there, thank you for your time.
Ian, Chicago, Illinois, USA, June 15, 2006

• I'm a 56 year old female with a high stress job as a clinical psychotherapist. I also just had a 100% blocked right coronary artery which received the Taxus Express -Paclitaxel-Eluting Coronary Stent system. The left LCA was 60% blocked and the doctor stated the artery was "too narrow" to operate on right now and that they won't work with it until it is also 75% blocked. He stated there's too much of a chance that if "something goes wrong with the one procedure, it's too easy to have the other artery crash as well." I was wondering if I should see someone else, but after all the emails I read I guess this is common. I also do not feel "great" like many people state after the procedure. I don't have a new burst of energy, still have trouble with breathing. I'm not sure I'm satisfied with his response. Anyone else have info on this post-procedure lethargy and anxiety about the other artery?
Jill S, Florida, USA, May 28, 2006

• hi i got my ct angiogram and has shown 49% blockage. my doc says that i must go for angiogram because the blockage may be up to 80% and then they will decide about angioplasty .. i need your i need this to be done or it can be cured by changing life style and medicines..he has advised me statin and aspirin 150mg
anil sabharwal, air india, delhi. india, March 20, 2006

• Hi all. Was diagnosed with Coronary artery disease via Angiogram done in Dec last. I have had AF (Chronic) for 6 years now, I am now 56 yr old male. Just had the Angioplasty to fix just one of the arteries (80% blocked). although I was told that the other 2 of them were around 50% blocked. I have been fitted with an approved stent as far as Europe is concerned but not approved by FDA. It's a bifurcation stent to fix a branch and front descending artery. Operation was OK, now on Plavix, Aspirin, Warfarin (AF) as well as sotalol for the AF and cozaar for high BP. Also need to get some Cholesterol lowering drug but Pravastatin brings me out in hives (not pleasant). I too have been given no indication of what or how I should try to get fitter, although this was always a prob due to the AF stopping me (of course it may have been the blocked arteries as well). Why would they not have stented the other 2 while they were in there? Any ideas?
Les C.., England, February 5, 2006

• Tom, as for exercise and your doctor's recommendation not to do any for a month, we always recommend following your cardiologist's recommendation, as long as you discussed this with him/her and have gotten answers to your questions. If there is something you don't understand as to "why", you should ask about it. It helps you as a patient to know. As to the other arteries at 60-70%, again without knowing your clinical info and seeing the angiogram, no one can make a recommendation, but most guidelines don't recommend doing angioplasty on less than blockages < 70% -- these usually can be managed with lifestyle changes and medications.
Angioplasty.Org Staff, Angioplasty.Org, January 5, 2006

• Last week I did my angioplasty and found a 95% blockage in one of my major arteries and that has been addressed with a Cypher Stent. The doctor also informed me that I had 60-70% blockages in my other two arteries but advised against any stent or plasty operation. Is this usual? He also advised I should not do any exercise for one month and I wonder how sticky this rule is?
Tom Lin, January 01, 2006

• Terry, more important than why you haven't gotten an angioplasty or another drug-eluting stent is, "are you adequately managed medically?" There are large trials which show that aggressive medical therapy can have less complication and deaths long tern than either open heart bypass or cath lab stents,'s just that interventional cardiologists are one of the few groups of docs in the US who can "self-refer". This is their income. In other countries such as the UK, cardiologists manage their patients health and prevention, and if they have to refer their patient to a cath, the patient goes to the center where the doctor does the test, then their daily cardiologist is consulted on what's right for the patient long term prior to rushing to do another procedure to them. Did he get your LDL cholesterol below 70? Does he keep your BP below 130/70? Does he control your blood sugar if you're a diabetic? Please make sure you don't smoke, you watch that diet, you need to insist on a "statin" drug even if your cholesterol is normal, and you need other meds such as beta-blockers and ACE inhibitors, daily aspirin....etc. The guidelines are in the AHA and ACC web sites. We all have responsibility as patients to follow all our physicians advice and quit relying on implants like stents to "forgive our sins".
Laura Lamkin, Louisville, KY, October 03, 2005

• Thanks I forgot to mention that the middle artery was stented about 2.5 years ago. Anyway on lots of medicine. Thanks again. Terry
Terry T., Florida, USA, September 28, 2005

• Terry -- there are a number of reasons why your cardiologist might not want to open the 50-60% blockage. The fact that your Right Coronary Artery (RCA) is 100% blocked is one of them. Should something go wrong during the angioplasty of the "widow maker" (the Left Anterior Descending or LAD artery) you'd be left with neither artery functioning. Also it usually is not recommended to do angioplasty on a blockage less than 70% -- the risks of any intervention, while small, outweigh the benefits. Moreover, even with a 50% blockage, a significant amount of blood still flows through the artery to the heart. Yours is a tricky, or complex, situation. Ideally it would be interesting to try and open up the totally occluded right. Technology for doing this is improving every day. We assume that you're on a number of medications, like blood-thinners -- certainly aspirin -- that also give you some insurance against blockage. When you questioned your cardiologist, did he/she give you any reasons why angioplasty needed to wait?
Angioplasty.Org Staff, Angioplasty.Org, September 28, 2005

• I had a light heart attack 10 years ago, cardiac ablation 5 years ago, I have the right coronary artery blocked 100%, and the widow maker at the last angio 50 to 60% blocked. My doctor tells me they will not open the 50 to 60% artery until it exceeds 75%. Why is this? wouldn't it help to open any blockage when you have one totally blocked?
Terry T., Florida USA, September 28, 2005

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