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Blockage in Left Main
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Melindaishere posted:
Hello, my 48 year old fit and healthy husband had a heart attack two weeks ago. The doctor put a stent in the right coronary artery. He also has blockage in the entrance to the left main artery and the doctor says bypass is the only option for it. I'm trying to find literature on this type of blockage but so far I can't find anything. Any input would be helpful. Thanks, Melinda
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CardiostarUSA1 responded:
Hi Melinda: The left main (LM) coronary artery feeds a massive left ventricular (LV) area. The LM arises from the aorta (the largest artery in the human body), typically 1 to 25 mm in length, with the diameter of a straw, and then splits (bifurcates) into the left anterior descending (LAD) and the left circumflex (LCX). HeartSite b Coronary artery anatomy Starting with the LAD, the most critical, next to the ultra-critical LM. www.heartsite.com/html/lad.html i Check out these interesting articles - theheart.org by WebMD Heartwire Interventional/Surgery b Stents equivalent to surgery in left main disease - March 31, 2008 There is no significant difference in major outcomes between stenting and CABG in patients with left main coronary artery disease, according to the results of the Revascularization for Unprotected Left Main Coronary Artery Stenosis: Comparison of Percutaneous Coronary Angioplasty vs Surgical Revascularization (MAIN-COMPARE) registry study. The findings were reported by Dr Seung-Jung Park (Asan Medical Center, Seoul, Korea) during a late-breaking session at the American College of Cardiology Scientific Sessions/i2 Summit-SCAI Annual Meeting and published online March 31, 2008 in the New England Journal of Medicine. www.theheart.org/article/852757.do b Angioplasty OK for Major Heart Artery b Study Shows Angioplasty May Offer Option to Open Blockages in Heart Artery That Supplies Most of Heart's Blood - April 1, 2008 Angioplasty may be a perfectly good option for opening up blockages in the major artery that provides most of the blood to the heart, South Korean researchers say. They studied people with blockages in the left main coronary artery. It supplies blood to the left side of the heart muscle, which is the side that pumps fresh blood to the rest of the body. Current guidelines call for these patients to undergo bypass surgery. www.webmd.com/heart-disease/news/20080401/angioplasty-ok-for-artery-clogs SCAI b Experts Debate Stents vs. Bypass for Left Main Coronary Artery Disease - May 11, 2007 The Stakes Are High in Artery Supplying Blood to Two-Thirds of the Heart Coronary artery bypass surgery has been the preferred treatment for patients with a blockage in the left main coronary artery, the conduit that supplies blood to about two-thirds of the heart. ☞However, in recent years this has been challenged by stent placement in this critical artery. Trusting treatment of such a critical vessel to percutaneous coronary intervention (PCI) is anathema to some. To others, it is the reasonable next step, given recent advances in stent technology. www.scai.org/pr.aspx?PAGE_ID=5078 . Best of luck to your 48-years-young husband and you down the road of life. Take care, CardioStar☆ Advocate for &Hearts;-Health - - b ☑Be well-informed WebMD Living With Heart Disease b Coronary Artery Disease (CAD) A chronic disease with no cure. When you have CAD, it is important to...... This is especially true if you have had an interventional procedure or surgery to improve blood flow to the heart...../It is up to you to take steps...... b Recognize the symptoms....... b Reduce your risk factors...... b Take your medications...... See your doctor for regular check-ups...... www.webmd.com/heart-disease/guide/living-with-heart-disease - ☞The hospital/medical center you choose can make a difference.....a critical difference. Choose wisely! i Credentials, Experience, Research U.S News & World Report b Best Hospitals: Heart & Heart Surgery www.usnews.com/directories/hospitals/index_html/specialty+IHQCARD . b ☛WebMD/WebMD message boards does not provide medical advice, diagnosis, or treatment. b ☛WebMD does not endorse any specific product, service, or treatment.
 
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vanRhyn responded:
Melinda, I had a bypass operation, carotis operation, aorta bifem. I heard of chelation therapy. I started 5 years ago with chelation therapy and all my arteries are clean now. Even the arteries that was blocked opened again. All thanks to the chelation therapy. :wink:
 
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moabu responded:
i have the same issue almost, the doctor indicated that i have 40% blockage in the left main, nothing to be done about it. except bypass. what was your research results , and could you share with me. thank you
 
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BillH99 replied to moabu's response:
More LM disease if being treated with stents, but there are some limitation that prevents it from being used every time. I don't know all of the limitations, but some of them are based on the SYNTAX score which is computed on the number, size, and location of the blockages.

Also there are other medical reasons that that stents are not recommended, but I don't know what they are.

I don't know what "doctor" told you this as there can be several involved. Cardiologist, interventionist that does the cath to see the blockages, and an interventionist that does the stenting. Probably in most case the last 2 are the same, but it wasn't in my case.

But you might want to look around in your area for one that specializes in the more difficult stenting and get a 2nd opinion.

Here are some recent reports on stenting vs CABG.

http://www.theheart.org/article/1199207.do

http://www.theheart.org/article/1114187.do


http://www.theheart.org/article/1048275.do

But stents are more likely to reblock and new additional treamtment.

Also with stents you will be on anticoagulants for a year.

That makes elective surgery difficult or even delayed.

In my case I had rotator cuff and hernia surgery about 5 months after CABG and TURP 6 months afterwards. Now the rotator cuff and TURP could have been delayed, but at a reduction in QofL. Specially with the TURP. I had the BPH under control with meds, but was having bad side effects.

And while the hernia repair might have been delayed it had the potential of becoming an emergency.

Now I don't know you health status, etc.

But I was 65, in generally good shape and active. About 30 lbs overweight, which I lost before the CABG; high BP, which is well controlled with meds; and near ideal cholesterol, LDL of 118.

But I got a 70% blockage in the LM at the bifurcation, and another one of the smaller vessels.

No heart attack or angina. Just SOB and fatigue on effort.

While CABG does have a little higher immediate risk factor the most "problem" that I had was chest pain from the opening of the ribs. That was mainly the first 2-3 weeks.

Other than not being able to lift more than 10 lbs for 6 weeks that was the only "side effects" that I had. And the Canadians are testing "glue' that will mend the chest in a couple of days. If tht becomes standard the pain and lifting restrictions will be gone.

And I have zero restricts and can exercise at maximum effort.

I would not hesitate to have CABG.
 
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James Beckerman, MD, FACC responded:
While some research studies have supported the use of stents in the left main coronary artery (see links mentioned in other community members' posts) - it is still not common practice in the United States, particularly in young, otherwise healthy individuals who would be expected to have a very good long term result from bypass surgery. My greatest concern with left main stenting is not the procedure itself, but the increased likelihood that the patient would require additional angiograms/stents, which could potentially increase overall long-term risk over many years when compared to surgery. It is definitely a difficult conversation.


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