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Burnsome-
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Posted: 1/18/2014 8:47:48 PM
so my dad (age 81) has been having TIAs (mini strokes) for a while and has a heart catherization yesterday with the assumption he has some kind of blockage, and put a stent in to do a fix-a-roonie. Cath doc shows me the images of 7 blockages (yeah, 7) in my dads arteries and he aint gonna touch it with a 10-foot pole as far as stents is concerned, and seys he needs by-pass surgery ASAP. so pops agrees lets do it, and they put him on heparin (sp?) to thin his blood before the surgery. he's scheduled for surgery early next week, so if any heart docs are in the house, can u tell me why u cant do stents to open up the 3 main arteries, versus doing by-pass surgery?

the cath test shows 95%+ blockage at 7 locations in the arteries on his heart. looks pretty damn fucked up to me, and the doc seys he cant fix all of them at one time and will need stents put in several of the blocked areas down the line later.

I aint no heart doc, but it looks pretty dam fucked up to me.

so if there are any heat docs in the house tonight, I'd appreciate some objective options of what the options are besides dying...and dying aint much of a livin" I've come to know. Cath doc seys he's gonne die unless he gets the by-pass surgery

bring me ur best ARFCOM.....
Him
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Posted: 1/18/2014 8:59:04 PM
Why aren't you willing to accept what you are being told?

Isn't it your dad's decision, anyway?

This isn't like cleaning scale out of a water pipe, you know.
Ever tighter grows the noose around the neck of the law-abiding.
Useafortyfive
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Posted: 1/18/2014 9:00:43 PM
Some drs will do high risk stenting in leu of open heart. Depends on where the blockages are and how bad the rest of his vessels are. Many factors come in to play actually.
Is he able to take anti platelet drugs (effient, plavix or brillinta)for long term?
Also high risk stenting will require a skilled interventional cardiologist. There are a lot of jackasses out there.
Eustice
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Posted: 1/18/2014 9:07:39 PM
A lot if factors come in to play when deciding if stents are the correct approach to the blockages. To place a stent, a guide wire must first be passed from the Femoral artery or Radial artery up to the heart and down the coronary arteries. If the blockages are too severe or the arteries are too tortuous (twisty) the wire may not be able to pass. And sometimes, even if they are able to pass the guide wire, they may not be able to get the stent through. A stent is basically chicken wire (on a smaller scale) that is passed into the blockage and a balloon is inflated, which expands the stent and leaves it behind once the balloon is deflated/removed).

Also, the lengths of the blockages may be too much. You say he has seven blockages but it may take more than seven stents. Each blockage may take 2,3, or even 4 stents if there are long segments of the blocked arteries.

Additionally, with diffuse disease, coronary artery bypass grafting (CABG) will be the longer term fix. Stents have the ability to occlude again, and sometimes at a very rapid rate. So if the first stent in a line if six stents gets occluded again, all the downstream stents aren't doing a bit if good.

Bypass grafting will use the Greater Saphenous Vein from his leg as well as either one or two arteries from his chest wall. This has a longer lasting effect because it is all his own tissue being used. And the recovery rates are pretty quick. 1-2 nights in ICU. 2-3 days in a step down unit. Home in 6-7 days, maybe even less.

TL,DR:
Sometimes stents just won't cut it
Grafting can give better revascularization and is better for the longer term.

Perfusionist.
Useafortyfive
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Posted: 1/18/2014 9:14:49 PM
[Last Edit: 1/18/2014 9:15:47 PM by Useafortyfive]
[Jump To Reply]Originally Posted By Eustice:
A lot if factors come in to play when deciding if stents are the correct approach to the blockages. To place a stent, a guide wire must first be passed from the Femoral artery or Radial artery up to the heart and down the coronary arteries. If the blockages are too severe or the arteries are too tortuous (twisty) the wire may not be able to pass. And sometimes, even if they are able to pass the guide wire, they may not be able to get the stent through. A stent is basically chicken wire (on a smaller scale) that is passed into the blockage and a balloon is inflated, which expands the stent and leaves it behind once the balloon is deflated/removed).

Also, the lengths of the blockages may be too much. You say he has seven blockages but it may take more than seven stents. Each blockage may take 2,3, or even 4 stents if there are long segments of the blocked arteries.

Additionally, with diffuse disease, coronary artery bypass grafting (CABG) will be the longer term fix. Stents have the ability to occlude again, and sometimes at a very rapid rate. So if the first stent in a line if six stents gets occluded again, all the downstream stents aren't doing a bit if good.

Bypass grafting will use the Greater Saphenous Vein from his leg as well as either one or two arteries from his chest wall. This has a longer lasting effect because it is all his own tissue being used. And the recovery rates are pretty quick. 1-2 nights in ICU. 2-3 days in a step down unit. Home in 6-7 days, maybe even less.

TL,DR:
Sometimes stents just won't cut it
Grafting can give better revascularization and is better for the longer term.

Perfusionist.

^this is pretty intelligent^ and pretty spot on too
Burnsome-
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Posted: 1/18/2014 9:38:51 PM
thanks Eustice. I'm not questioning anybody. just trying to learn as we go thru this process. appreciate the explanation there
Him
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Posted: 1/18/2014 9:46:30 PM
[Last Edit: 1/18/2014 9:52:58 PM by Him]
Tell your dad to do the post-op rehab as soon as he is ready.

Have your local Visiting Nurse come to your house to assess his progress, and answer any questions you, or he, may have.

Get him walking, if only around the house, as much as he can, don't let him just sit in a chair.

Good luck to him.
Ever tighter grows the noose around the neck of the law-abiding.
NwG
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Posted: 1/18/2014 9:49:44 PM
If you would like a second opinion I could ask my father to look at the chart for you..

Not trying to brag but he is one of the leading cardiologist in the country..

PM me if you like, I can put you in contact with him..

Nate D
look close in the background you can see the top of a 155mm DCIPM round. There are pics involving this, they will not be posted.. If you have an imagination think Slim Pickins meets suicide girl.
ronin556
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Posted: 1/18/2014 9:55:16 PM
Dear idiot patient family.

Your docs are following the text book standard of care.

Iin fact if a cards recommended multiple stents for multivessel disease. I would think he is nuts or
dishonest.
NwG
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Posted: 1/18/2014 10:03:24 PM
[Jump To Reply]Originally Posted By ronin556:
Dear idiot patient family.

Your docs are following the text book standard of care.

Iin fact if a cards recommended multiple stents for multivessel disease. I would think he is nuts or
dishonest.


You must be a doctor... I can't read shit that you wrote!!

look close in the background you can see the top of a 155mm DCIPM round. There are pics involving this, they will not be posted.. If you have an imagination think Slim Pickins meets suicide girl.
WTF54
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Posted: 1/18/2014 10:03:59 PM
[Last Edit: 1/18/2014 10:08:06 PM by WTF54]
some good info posted in here
NwG
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Posted: 1/18/2014 10:12:11 PM
OP, the healing process for open chest operations is a whole lot less painful and with good rehab started early it is nowhere as scary as it was when we were younger.

Though the scars aren't as cool as they used to be... Chicks dig scars..
look close in the background you can see the top of a 155mm DCIPM round. There are pics involving this, they will not be posted.. If you have an imagination think Slim Pickins meets suicide girl.
lilMAC25
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Posted: 1/18/2014 11:05:19 PM
[Jump To Reply]Originally Posted By Eustice:
A lot if factors come in to play when deciding if stents are the correct approach to the blockages. To place a stent, a guide wire must first be passed from the Femoral artery or Radial artery up to the heart and down the coronary arteries. If the blockages are too severe or the arteries are too tortuous (twisty) the wire may not be able to pass. And sometimes, even if they are able to pass the guide wire, they may not be able to get the stent through. A stent is basically chicken wire (on a smaller scale) that is passed into the blockage and a balloon is inflated, which expands the stent and leaves it behind once the balloon is deflated/removed).

Also, the lengths of the blockages may be too much. You say he has seven blockages but it may take more than seven stents. Each blockage may take 2,3, or even 4 stents if there are long segments of the blocked arteries.

Additionally, with diffuse disease, coronary artery bypass grafting (CABG) will be the longer term fix. Stents have the ability to occlude again, and sometimes at a very rapid rate. So if the first stent in a line if six stents gets occluded again, all the downstream stents aren't doing a bit if good.

Bypass grafting will use the Greater Saphenous Vein from his leg as well as either one or two arteries from his chest wall. This has a longer lasting effect because it is all his own tissue being used. And the recovery rates are pretty quick. 1-2 nights in ICU. 2-3 days in a step down unit. Home in 6-7 days, maybe even less.

TL,DR:
Sometimes stents just won't cut it
Grafting can give better revascularization and is better for the longer term.

Perfusionist.

Nice to know there are a few "pump techs" like me on the board!

Texas Heart 2003.
lilMAC25
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Posted: 1/18/2014 11:07:37 PM
[Last Edit: 1/18/2014 11:07:58 PM by lilMAC25]
[Jump To Reply]Originally Posted By NwG:
OP, the healing process for open chest operations is a whole lot less painful and with good rehab started early it is nowhere as scary as it was when we were younger.

Though the scars aren't as cool as they used to be... Chicks dig scars..

+ this. My dad had a CABGx3 a few years ago (he's 65) and us doing quite well. Probably extended his life by 10 or so years,
bstonemega
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Posted: 1/18/2014 11:08:54 PM
[Jump To Reply]Originally Posted By Useafortyfive:
Originally Posted By Eustice:
A lot if factors come in to play when deciding if stents are the correct approach to the blockages. To place a stent, a guide wire must first be passed from the Femoral artery or Radial artery up to the heart and down the coronary arteries. If the blockages are too severe or the arteries are too tortuous (twisty) the wire may not be able to pass. And sometimes, even if they are able to pass the guide wire, they may not be able to get the stent through. A stent is basically chicken wire (on a smaller scale) that is passed into the blockage and a balloon is inflated, which expands the stent and leaves it behind once the balloon is deflated/removed).

Also, the lengths of the blockages may be too much. You say he has seven blockages but it may take more than seven stents. Each blockage may take 2,3, or even 4 stents if there are long segments of the blocked arteries.

Additionally, with diffuse disease, coronary artery bypass grafting (CABG) will be the longer term fix. Stents have the ability to occlude again, and sometimes at a very rapid rate. So if the first stent in a line if six stents gets occluded again, all the downstream stents aren't doing a bit if good.

Bypass grafting will use the Greater Saphenous Vein from his leg as well as either one or two arteries from his chest wall. This has a longer lasting effect because it is all his own tissue being used. And the recovery rates are pretty quick. 1-2 nights in ICU. 2-3 days in a step down unit. Home in 6-7 days, maybe even less.

TL,DR:
Sometimes stents just won't cut it
Grafting can give better revascularization and is better for the longer term.

Perfusionist.

^this is pretty intelligent^ and pretty spot on too

And reminds me how advanced our medical technology is.
Eustice
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Posted: 1/18/2014 11:08:54 PM
Pump Monkey

UPMC Shadyside 2003

If you took your boards in spring of '04 in San Diego, we were in the same room.
eastonj
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Posted: 1/18/2014 11:18:21 PM
[Jump To Reply]Originally Posted By lilMAC25:
Originally Posted By Eustice:
A lot if factors come in to play when deciding if stents are the correct approach to the blockages. To place a stent, a guide wire must first be passed from the Femoral artery or Radial artery up to the heart and down the coronary arteries. If the blockages are too severe or the arteries are too tortuous (twisty) the wire may not be able to pass. And sometimes, even if they are able to pass the guide wire, they may not be able to get the stent through. A stent is basically chicken wire (on a smaller scale) that is passed into the blockage and a balloon is inflated, which expands the stent and leaves it behind once the balloon is deflated/removed).

Also, the lengths of the blockages may be too much. You say he has seven blockages but it may take more than seven stents. Each blockage may take 2,3, or even 4 stents if there are long segments of the blocked arteries.

Additionally, with diffuse disease, coronary artery bypass grafting (CABG) will be the longer term fix. Stents have the ability to occlude again, and sometimes at a very rapid rate. So if the first stent in a line if six stents gets occluded again, all the downstream stents aren't doing a bit if good.

Bypass grafting will use the Greater Saphenous Vein from his leg as well as either one or two arteries from his chest wall. This has a longer lasting effect because it is all his own tissue being used. And the recovery rates are pretty quick. 1-2 nights in ICU. 2-3 days in a step down unit. Home in 6-7 days, maybe even less.

TL,DR:
Sometimes stents just won't cut it
Grafting can give better revascularization and is better for the longer term.

Perfusionist.

Nice to know there are a few "pump techs" like me on the board!

Texas Heart 2003.

Excellent info from Eustice. I'm a doc (but not a heart guy). If he has very proximal disease (the blockages are very near to where the coronary arteries exit the aorta), they may not be able to stent them. It could leave the end of the stent sticking into the valvular area, it could cause turbulent blood flow, and increase the risk of clot formation, endocarditis, and endocardial damage. You could have narrowing at a branch point (a fork in the road). If you stent one fork, you're effectively blocking the other fork.

Most cardiologists will not stent a proximal left main or right main stenosis (although there are always patient-specific factors to consider). Also, with severe disease, they'd have to place multiple stents, one after another. Essentially, each artery would be one big chain of stents. When you get to that point, it's CABG time.

Look at it this way: Cardiologists like doing stents. They're pretty cool, they're technically challenging, and in the appropriate candidate, they can cause a dramatic improvement in quality of life. If all of the last sentence is true, and a cardiologist is still recommending coronary artery bypass grafting, it's probably for a really good reason.

My cousin is a cardiothoracic surgeon (and I stayed at a Holiday Inn Express last night). I had a fellow church-goer who was a perfusionist. They do very good work. I hope I never need one for myself.

Good luck to you both.
"The best argument against democracy is a five-minutes conversation with the average voter." Winston Churchill