Stent or CABG option

[barniecroft]

I cant figure this out. I had a stent fitted a month ago and have disease in three vessels. Someone i was talking to at rehab had similar disease and was offered either a stent or CABG. They went for CABG as the Dr said best option. It got me wondering - were they offered CABG as they had worse disease than me, should i have been offered CABG or is it just the luck of the draw/whim of the DR on the day as to whether it is offered ???

[Allen224]

Hi ya , I can’t see it being offered but surely it depends on how severe the blockage or the damage to that particular artery which would make it unstentable . Anyway stents are such the easier option and if it works for you a much safer one too. I my opinion anyway.

[Andie1975]

Ive wondered about the same thing. I had 75-85% blockage in LAD Requiring 3 stents and a 95-99% in RCA requiring one stent. 4 in total. i see a lot of people only requiring one or two stents and wonder why I didn't need a bypass. My post stent result was 0% blockages with only mild atheroma to RCA, so maybe the plaque was soft and not very calcified or something so stents could easily open arteries up. I'm just guessing at that though, I'm still not sure and I forgot to ask cardiologist.

[MichaelJH Heart Star]

The book I read when I was diagnosed with CVD over a year ago suggested if the LAD and two other arteries were affected then it was bypass territory. It did add that if the LAD was affected along most of its length then you were again looking at a bypass.

Things then get more involved as if someone does not follow the advice given a bypass may only last ten years and redos are more complex. It appears if the patient is thought to potentially be in this category stenting if possible is a good starting point.

Then issues of the person's general health (risk of major surgery) and specific medical issues (e.g. if PAD is present bypassing has a higher success rate).

It is not necessarily a straightforward decision and I think you need to trust your cardiologist. You are entitled to a second opinion but it could delay treatment.

[Andie1975 in reply to MichaelJH]

That's interesting Michael. I wonder just how much of my LAD was involved all I know is that the stents were placed in the proximal section. I remember everything happened so quickly that I didn't even consider questions til much later. I had an 18mm 30mm and 12mm in lad so that's 6cm in total, sounds quite a long portion but again I don't know if they were overlapping or placed in different parts etc. The stent in my RCA was 48mm, which again seems long. The report afterwards stated excellent result with post pci 0% in all arteries apart from mild atheroma in RCA. I will never know why they didn't choose bypass although at 42 they might have thought it best to wait and I'm glad as I am scared of that scenario.

[MichaelJH Heart Star in reply to Andie1975]

The coronary arteries are not straight lines and typically the LAD is 10 - 13 cm in length. I had a quadruple bypass because of severe calcification. Although routine it is a major operation! I came around feeling like I had been the victim of a Big Daddy Splash. However, a few days later I realised the angina and breathlessness were gone. Rehab in two weeks

[Rosei in reply to MichaelJH]

I have got as far as Coronary by pass surgery, pleas tell me what the G stands for, thank you.

[MichaelJH Heart Star in reply to Rosei]

Coronary Artery Graft Bypass

[Berniel69 in reply to MichaelJH]

Coronary Artery Bypass Graft

[Rosei in reply to Berniel69]

Thank you.

[Rosei in reply to MichaelJH]

Thank you

[Karenpr]

Interesting when husband had Cardiac Arrest he received three stents and doctor told my daughter and I that there was further damage that they could not stent as there it would be difficult to attach the stents (?) I do remember asking what would happen and he said we’ll see. At the follow up cardiac appointment some nine months later cardiologist denied this was the case.

Following a echo cardio and a second appointment husband was discharged from service as the heart had recovered amazingly. I asked again about other damaged, this time the registrar looked at notes and said yes there is damage but no need to do anything, obviously if husband suffers any pain or breathlessness then come back.

I still wonder tho from first conversation whether the damaged arteries are a ticking time bomb. I am sure I asked about a by-pass but was given no answer. Heyho we wait and see.

Maybe ask your cardiologist and see what they say if you are really worried or it could be that the damage is not so bad and following advice it’s liveable with

[IgottaStent]

CABG is a major event with scars left on chest and legs. Stent is a more “comfortable” option. If your cardiologists prefers to make a small incision in groin or wrist it’s preferable to opening chest and heart arteries. I’d go for least invasive option and be under respectfully modest observation.

[esherm]

I think sometimes people can’t have stents because the structure of the blood vessels near the heart are abnormal so a CABG is their only option

[wiltsgirl]

I was also told by the rehab nurses that generally CABG is done on younger patients, not sure how accurate that is.

[Fortepiano]

Bypass is chosen if all three arteries need intervention. It sounds from your post that only one artery needed a stent while the other two have a lesser degree of stenosis and are therefore being treated with medication/ lifestyle measures.

The chap who had a bypass probably needed intervention on all three arteries and therefore had bypasses to all three.

If you keep on with rehab / medication / diet / exercise, hopefully you will keep your coronary disease under control and have no further problems.

[Allyboy1973]

I first received stents which closed over after 6 months and then was told I was to get a bypass . I wasn't given an option and don't think most folk are it's down to how bad the surgeon thinks your condition is and ultimately it's their decision .

[Twobells]

I wasn't given the option a team discuss the option that's best outcome. I would have the stents than CARG. I discussed this withthe cardiologist, he said given how young you are the only option is bypass, he said that stenting would not have worked for all 3 vessels only on oñe. It just depends on individual health, weight, long term health conditions. I think you have to leave it to the professionals to make the decision which option they give you. But if you needed a bypass you would have one. Stenting is a lot less evasive, recovery is faster, but it still doesn't mean the one has stents and another person has a bypass that either of them are more ill than the other. A heart attack is traumatic and whether you have bypass or stents as long as it stops further HA and you recover just thank that your still here to tell your story.

[barniecroft]

How can stenting not add a day to life expectancy when without immediate stenting many would be dead??

[MichaelJH Heart Star in reply to barniecroft]

It is a ridiculous statement - I have seen it on the internet made by what I consider a quack! A friend went to his GP with what he thought was bad indigestion. His doctor decided it was a heart attack and called an ambulance. In the ambulance he arrested but thanks to the skill of the paramedics he was resuscitated and taken to the angioplasty theatre. One artery was stented and three days later he was home. He is now three months on. So stenting has extended his life!

[MichaelJH Heart Star in reply to barniecroft]

I have no wish to rubbish anyone but I dislike statements that are not based on rigourous scientific evidence! Also suggesting that non-emergency stenting does not add an extra day of life, as Malhotra does, could be distressing for those patients. For those who who were potential heart attacks suffering with angina and other symptoms who have received stents and returned to a normal angina free lifestyle this is clearly not the case.

One thing that has been shown is that because stenting is minimally invasive whereas a bypass is the other end of the scale the impact on the patient is less and adherence to lifestyle changes lower!

[barniecroft]

Could you provide a link to those statistics if possible please - I would like to read them. From information i have read these stent questions arise in context to stable angina rather than other coronary complications. If this is the case then context is everything. I think Cholesterol does have a significant impact based on evidence available on the internet and whilst insulin is applicable regarding heart disease and diabetes - it is in my view just one sub-set of heart related issues

Thank You

[Emily_BHF]

Hi barniecroft,

I can appreciate that must sound confusing. However, people with coronary artery disease requiring intervention are always offered angioplasty and stenting first. If the disease is more severe then they will have to have a bypass. This is a higher risk procedure and only performed when stenting would not be enough to provide effective revascularisation as the level of disease is too severe or it is a difficult part of the artery to place a stent.

I would recommend discussing this with your doctor if you have any other concerns.

There is more information about this on our website bhf.org.uk

Take care,

Emily

[David-75]

I think it really does matter on the individual age, weight , the exact location and extent of severity. At age 42 I have stents in all 3 - 5 in total ; Circumflex x 3 , 1xLAD distal and 1xRCA proximal. Both options were discussed after my HA- but they decided stents were the best option with the view that in the long term I may need to have CABG - hopefully not , but probably unavoidable although cardiologist stated stents could “last a lifetime “ (hopefully he means a long life!). I went from 75-95 in two and 100% in the other to mild atheroma in all ( and I ran two half marathons only five years ago - lol). Others I have heard of having ten or more stents... so there really must be a huge variation in individual circumstances that are the ultimate deciding factors. What I would like is a way of monitoring which is non-invasive.... all the best to everyone.