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To Stent or Not To Stent

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Readers ask whether or not angioplasty and/or stenting is necessary in a particular situation.

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Current Postings on This Page (9):

• Sudhir -- It's certainly possible to open a 100% blockage, but only an experienced interventional cardiologist (one who does stenting) can advise whether this specific blockage is possible.
Angioplasty.Org Staff, Angioplasty.Org, April 10, 2013

• my father is 63 yrs old and have history of BP and SUGAR. But 2 days before he has complained chest pain in night. 2nd day in morning doctor told after seeing ECG n ECO there is a problem. 3rd day we go for angiography and doctor said he had blockage in 2 arteries. One 100% blocked and 2nd is 70% blocked and 2 other blockages in the branches of these two. So please advice my what to do. And tell me is it possible to stenting in 100% blocked artery.
Sudhir, Delhi, India, March 31, 2013

• To student in Kolkata -- Sounds like your father had an episode, possible small thrombus which got dissolved. We can't give medical opinion in place of a doctor and he should definitely be in the care of a cardiologist who can help with these decisions. One question is whether or not these blockages are causing ischemia, although the 80% probably is. A nuclear stress test might show if this is the case. If your father is not already taking clopidogrel and aspirin, his doctor may want to put him on these as well to prevent a future attack. Unless he is suffering acute coronary syndrome, unstable angina, it doesn't sound like you're in an emergency situation. But he should do what he can to reduce all risk factors (stop smoking, watch diet, exercise, etc.). And see his cardiologist.
Angioplasty.Org Staff, Angioplasty.Org, February 15, 2012

• My father 63yrs old non diabetic, non hypertensive complained of sudden onset mild rest chest pain,we did a ECG, it showing 1 mm ST elevation in lead V1 & V2, which was disappeared within 2 hrs after giving Clopidogrel, aspirin,and isosorbide mononitrate, and chest pain disappeared completely and ECHO showing no wall motion abnormality, EF-65% , CK-MB was within normal limit. But angiography on next day showing 70% blockage in prox & 80% in mid LAD. now what to do, should we go for PTCA with DES or continue conservative therapy as he is telling that he has no problem with normal physical activity right now. Plz give an urgent reply if possible.
To Stent or Not To Stent, student, Kolkata, West Bengal, India, February 13, 2012

• Neil -- Did you ever have the Thallium stress test? That would show if there is a significant oxygen deficit to your heart. Stenting was most likely refused because the blockages were total (also known as a chronic total occlusion or CTO) and judged too difficult to open. There are cardiologists who specialize in this but it's also possible that your body has built up collaterals bridging the blockage somewhat, or that your right coronary artery, which is open, is the dominant one. One problem with surgery might be your accompanying clinical conditions, but that's something for the surgeon to decide. The best thing is for an interventional cardiologist and a heart surgeon to consult on your case and present you with the risk/benefit of a given therapy.
Angioplasty.Org Staff, Angioplasty.Org, December 20, 2011

• I'm 72 yrs old & i had a cerebral attack (brain haemorrhage in 2007) from which i had partially recovered. Nov.28,2011 i had a heart attack & after angiography test 2 arteries-Left Anterior Descending(LAD) & Left Circumflex (LCx) were found to be 100% blocked. Doctors at AIIMS-N.Delhi & Safdarjung Hospital had refused Stenting (Angioplasty) & referred to Rest Thallium test for further diagnosis. Going by my age & physical condition will bypass surgery be a good solution or does anybody have a brighter or less dangerous solution or idea for partial resolution. I also have small asthmatic bouts once in a blue moon & take external oxygen support for that.
Neil, New Delhi, India, December 15, 2011

• Recently i went for a normal check up in Delhi Escorts hospital and the doctor advise me angiography and in the table while my catheter pipe was inside told me that my 2 artery is block 90% and 80% he panic and put 2 drug coated stunts [stents] but when i went to other doctors with my angiography CD all the doctors said there was no blockage . how to save from this kind of fraud and cheating what is the method to find out actual blockage because in India specially in Delhi doctors are cheating patients.
KM, Mumbai, India, November 30, 2011

• Dear Looking in New Delhi -- this is not an "ask the expert" forum, so nothing stated here should be taken as a substitute for medical advice. We can say that a 90% blockage, if it has been accurately measured, usually benefits from revascularization (opening of the artery either by angioplasty/stenting or bypassed with surgery). We say "usually" because, like anything in medicine, each diagnosis must be specific to the patient and his/her clinical profile. One tool that is being used more and more to accurately measure the percentage of arterial obstruction, especially in cases of multivessel disease like the one you describe, is Fractional Flow Reserve (FFR). This is performed during angiography (or just before stenting) to measure the actual blood flow across a blockage. See our article "To Stent or Not to Stent: FFR" for more specific information, but bottom line in this study was that only 1 out of 3 blockages measured by angiography in the 50-70% range was actually causing ischemia; in the 70-90% range it was 4 out of 5. This somewhat parallels what your doctor recommended, although we're not sure if he/she used FFR.
Angioplasty.Org Staff, Angioplasty.Org, April 22, 2011

• I would like to have your expert opinion for the one case where the patient have undergone routine checkups with below procedure:
1. ECG - Normal
3. Treadmill Test :Exercise Duration: - 7:17 minute
Max. Heart Rate: - 140bpm, 93% of target heart rate 150bpm
Max Blood Pressure: - 180/80mmHg
Max Work Load: - 8.35 METS
Reason of Termination: - Fatigue
Result: - Test is Positive for Exercise induced Reversible Ischemia
4. Angiography: - During Angiography Doctor found appx 90% blockage in 2 heart Arterial and whereas for the 3rd Arterial 70% blockage exists.The existing diseases with the patients are 1. Diabetics: - is in control with exercise; 2. Enlarged prostate glands (Grade-III) :- No Medicine yet started Presently even in the past there are no symptoms with the patient relating to heart problem like Chest Pain, Respiratory Disturbance, Nausea, Weakness:, Verbal Disruptions:, Blindness etc. The patient is age is 70 yrs. As per doctor the patient should go with Angioplasty with stunt [stent] for arterial (with 90% blockage ) and for the 3rd one will take care by medicine. I would need your expert advise here there really need to go with the Angioplasty?
Looking for Expert Suggestion, New Delhi, India, April 16, 2011













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