stent or bypass graph ?

[Lemon31]

after a heart attack and stent fitted in August 2023, was still getting chest pain. On the 19th December 2023 had another angiogram found another blockage 99 per cent they had missed. Tried to put a stent in but after a hour and a half was unsuccessful. Had a lot of chest pain afterwards. Was kept in hospital now home on a virtual ward waiting to see if they are going to try a stent again or go for a bypass graph. Said it is my decision. I just don’t know what to do.

[Bluehope81]

Not medical advice, opinions and suggestions.

Bypass graft, would be my choice, assuming both operations went smoothly,

You will also need to adopt a strong anti plaquing therapy after, to stop the CAC developing in the graft especially around the junctions.

Stong anti-plaquing therapy = medicines (usually more than just statins), healthy diet, exercise as advised, possible supplements.

Graft could potentially last 20 years and new treatments would be available then.

Also I would ask to be placed on a different anticoagulant to Warfarin, possibly Heparin or one of the newer anticoagulants. If for some medical reason the only drug available was warfarin I would opt for the stent.

Calcification of coronary arteries is a well-known risk factor for mortality in ischemic heart disease. Poterucha TJ et al. [14] demonstrated that the use of warfarin was associated with increased systemic calcification, including calcification of the coronary arteries and the surrounding vasculature.

[Lemon31 in reply to Bluehope81]

thank you so much for your reply. It is good to know. I am going towards a bypass graph but still have niggling doubts. Apparently it would be a small incision and not the large one in the middle of the chest.

[Bicesterwhite in reply to Lemon31]

Hi Lemon31, i had a quadruple bypass 18 months ago (aged 58) and although it was a massive shock at the time, that was the advice from the consultant, as the best outcome for my future. Big scare later and longish recover period, have more energy than I had for years, Now doing more exercise diet improve ( but still could be better) #noregrets. Best wishes

[Ironfloor173 in reply to Bluehope81]

I recently had my HB X3 postponed due to an infection. I have never had any symptoms and mine was a silent HA discovered when I went for a head scan. I have been on Warfarin for years due to a blood disorder. I am also on Aspirin since my silent HA was discovered. No one has mentioned that Warfarin can make matters worse. Do you have a link to what you researched as I am quite concerned after what you reported?Many thanks.

[Bluehope81 in reply to Ironfloor173]

Fair few studies out there:

Anticoagulants

Effects of direct oral anticoagulants (DOACs) and warfarin on plaque progression have been assessed in several studies. Lee et al (117) (2019) randomized 97 patients with AF to either rivaroxaban or warfarin, with the latter resulting in increased total plaque volumes measured by CCTA from baseline to 12 months. Similarly, Win et al (118) (2018) randomized 56 patients with AF to apixaban or warfarin with the latter resulting in increased total plaque and low attenuation plaque volumes from baseline to 12 months. Beyer et al (119) (2019) used CCTA to assess changes in absolute plaque burden in an observational cohort of 161 patients, showing greater reductions in plaque burden at 38 months in patients treated with DOACs compared with patients taking warfarin or neither (absolute plaque burden DOAC −7.1 mm3, warfarin +66.5 mm3, control subjects +27.2 mm3; P < 0.05).

ncbi.nlm.nih.gov/pmc/articl...

Low Attenuation Plaque, LAP, its bad, it's soft and mushy, with limited structure or rigidity and can easily break off.

[ChoochSiesta]

The Consultants decided for me. They said a bypass would give the best outcome. In your case if they can't decide then the angioplasty is a far, far less invasive procedure than a bypass and I would go for angioplasty.

[Lemon31 in reply to ChoochSiesta]

Thank you for your reply. I am thinking this might be the best outcome too.

[BeKind28-]

Hello

For me when I had my heart attacks the angiogram showed them that where some blockages were it was going to have to be a triple Bypass

In a way I am glad they told me rather than give me a choice but had I been given one I think I would have gone for the Bypass operation

I hope your replies will give you something to think about so you can make the right choice for you x

[Lemon31 in reply to BeKind28-]

Thank you for your comments. I am definitely thinking bypass as don’t want to go for stent again and it fails and have to have bypass anyway.

[BeKind28- in reply to Lemon31]

Hello

That would be my way of thinking to but if you do decide to go for the Bypass and I am so anxious in general it is not bad at all nothing like I thought it would be

I look forward to hearing how you get on x

[Lemon31 in reply to BeKind28-]

Thank you so much x

[BeKind28- in reply to Lemon31]

x

[Qualipop in reply to Lemon31]

If they've already struggled to fit a stent, it's either in a difficult position or has other problems so I would be concerned and would opt for bypass.

[Chappychap]

My bypass surgery was the best gift I've ever received, I feel full of life and energy, literally ten or even twenty years younger.

But, and this is a huge but, I was 62 when I had my surgery, where as you're only 53.

The problem with bypass surgery is that for the vast majority of people the grafts will eventually fail. On average this takes about 15-20 years. For some it's sooner, for other longer, but most of us aren't far off 15-20 years. I'm hoping that a radical change in life style might stretch me out to the full 20 years, or maybe even a year or two longer, so taking me to my mid 80's. But for you the arithmetic looks quite different.

In your place I'd want to be convinced that every option for stenting had been fully explored before moving on to bypass surgery.

Just my 2p's worth. Whatever your decision I wish you the very best of luck!

[Lemon31 in reply to Chappychap]

Thank you for your reply this is good to know.

[Survivor1952]

I had no choice. Two PCI (stents) placed in May and checks after that showed a regurgitating valve.

So it was OHS for AVR and whilst in there they did a CABG on one blood vessel they couldn’t stent.

As for anti platelet medicine (blood thinners) I’m on Ticagrelor and aspirin. The Ticagrelor is for one year only. Warfarin has issues associated with its use especially in those with hypertension (high blood pressure).

[Lemon31 in reply to Survivor1952]

Thank you so much for your reply. It is good to know other people’s experiences.

[DWizza]

Aged 61 I had Nstemi in July this year, the angiogram showed blocked arteries and stents were not the right option, 99% block in one artery but I was told I needed 3x bypass. My consultant explained that CABG would be the best option , they had considered trying stents but the longer term outcome wouldn’t be as favourable in their opinion. I ended up with 4xCABG. I’m Making a remarkable recovery , already achieved 2 x 5k runs and back to lifting weights . Was riding my motorbike within 2 months.

A couple of minor lifestyle changes and my cholesterol stats are fantastic. BP is great too. I have one job to do and that’s keep these new pipes clean 👍, I intend to get the full use out of them.

[Lemon31 in reply to DWizza]

Thank you for your reply. I am glad you are doing well. This is very positive.

[DWizza in reply to Lemon31]

Will be celebrating on Xmas day , 5 month old new pipes 🤣.. I’m sure you’ll be able to discuss the pros and cons with your medical team. The surgeons will be pretty blasé about CABG, “ oh it’s just plumbing and sewing these days, we do thousands a year. The hardest job is for the anaesthetist , they do all the work “ That’s what my surgeon said and added “ you’re so young and fit , we normally deal with people a lot older and frailer , you’ll make a full recovery ….”

[Bookworm60 in reply to DWizza]

Can I ask what your minor lifestyle changes were? Sounds like you were pretty healthy before the op if you were previously lifting weights etc...My cholesterol is high though I'd say my diet is pretty healthy.Thanks

🙂

[DWizza in reply to Bookworm60]

Hi ,

I don’t eat ultra processed foods such as ham, sausages , supermarket pies , charcuterie etc

I do eat tinned baked beans and carton custard as a treat. I tend to make my own homemade bread , lower salt & sugar. Use a statin spread such as proactiv or whatever is on offer. I added nuts and oats to my snacks with fruit and Greek yoghurt (0% fat). I drink skimmed milk by the glass , I’m sure that’s helped my sternum repair as well. I try and stick to nutrition that is natural as possible . If you can find it in nature then generally ok. I have reduced hidden sugars .. really cut back on condiments such as sauces , pickles , chutneys in favour of fresh herbs and spices . Even on poached egg , tomato ton toast I have fresh cut basil and parsley and white pepper. So tasty.

I don’t drink anywhere near as much alcohol now, well below the 14 units a week if any at all. Guinness zero is my go to or a lemonade. I’m not tea total though , I enjoy a couple of pints in company or a halls of wine . I have a very good rum collection sitting a cupboard 🤦🏼🤣

If you have access to Instagram I post my meals and rehab on there as Wizza2018 if it helps you, only too glad to share experiences .

I had my liver cholesterol results back last week, couldn’t be more pleased

Serum cholesterol 2.4 mmol/L ( 5 or below)

Serum triglyceride 0.9 (2.3 or below )

Calculated LDL 0.7 (below 3)

Serum HDL cholesterol 1.3 ( 1 or above)

Se non HDL 1.1 (4 or less)

Serum cholesterol/HDL ratio 1.8 ( below 3.5)

[Bookworm60 in reply to DWizza]

Thanks for taking the time to reply. Like you I steer away from processed foods generally and always cook rather than buying ready meals or takeaways.Lots if fruit and veg. Rarely eat meat. However I am still eating quite a lot if cheese , can't resist chorizo and deffo push the boundaries on the 14 units if alcohol per week... Kidding myself a bit when I say my diet is healthy I think. Maybe bed to think again 2024. Will look you up on Insta.Thanks!

[momander]

Hi,I hada similar experience to you. I had a double cabg in Jan this year and I feel great. It is up to you but the cabg reaĺly has saved my life. Good luck

[Lemon31 in reply to momander]

Thank you this is very positive.

[Mitchum]

I may add that IF you do need to take warfarin do not be afraid. It's kept millions of people alive for decades. Me included!

[Silvertail]

My husband had a quadruple bypass in early 2000 - nearly 24 years ago. (His blockages were at junctions so stenting was not possible.) So far he's still going strong. Fingers crossed that he continues to do well.

[Butcharts]

After developing unstable angina, I had. Quad CABG in August 2015 at age 66, retired but part time ski instructor at local dry slope. Decided to recuperate by spending the following winter in Austria. However, breathlessness began to return, and after speaking to GP at home, consulted an Austrian GP, who sent me to hospital in Austria for further tests. Given an immediate angiogram.

3 of my 4 grafts had failed and they inserted 7 stents in my original arteries. Still going 8 years later, and still able to enjoy my skiing. Currently back in Austria for festive season.

I wasn’t given any choice of treatment in UK or Austria, and would have found it very difficult to decide. Grafts are not infallible in my personal experience, but I would push the medics for a more experienced view.

Austrian treatment was superb, and paid for with EHIC, now GHIC, card.

[wilberwoo]

Bypass surgery takes time to get over but having been through both I would go for a bypass. Had mine 17 years ago and the artery is still working fine. Good luck!

[RailRover]

Similar path to me. HA and one stent to RCA Dec 19. Other arteries diseased but too tortuous (curved) to stent. 18 months later symptoms creeping up on me again so went for triple bypass. Good so far. Back to my badminton and regular exercise. Random aches and pains but nothing that's stopped me up to now. Nothing is infallible of course, and we don't know what's around the corner, but that's the same for everyone.

[Jedi14]

I am writing to you, as I have experiences of both procedures! My Mrs had a double by pass, she was not given any choice and neither did we have any advice on stents.

All I can say about the bypass operation was that it was successful and post operative care is essential and long winded, it took a long time post operative care with several medications, finally recovering, she was on pain killers for long time (approximately 3 months).

So recently it was my turn, I had a heart attack, whilst at home relaxing, ended up in hospital. The angiogram showed several blockages and I was immediately recommended a triple bypass as the best solution, but in passing, my consultant also said "we might getaway with stents", this stuck in my mind! The thought of me going through the operation scarred me, I was terrified by the length of time for recovery (12weeks).

Whilst they were preparing me for the operation, I consulted doctors and Dr Google and opted to have stents!

6 stents later (relatively pain free) I was back at home and back to work fulltime. So in essence you must have confidence in the consultants/surgeons whatever you choose to do!!!I think that my stent surgeon/s did a marvelous job!

[CalvinHb]

I had triple bypass at 51. Feel 10-20 years younger!

The procedure and recovery were far more straightforward than I could ever had expected.

The long term outlook is much better than stents (according to current research). My advice would be the up front investment is well worth the long term payoff.

[Stevie335 in reply to CalvinHb]

Thats good to hear Calvin, i have been waiting 12 months for quad cabg, im 44 got my pre op appointment on thursday 11th jan where they will give me a date

[CalvinHb in reply to Stevie335]

Hope it all goes well Stevie, you’ll feel like a new man after it!