Multi vessel stenting vs bypass surgery

Posted by cathysudlow6 @cathysudlow6, May 2, 2020

Hi wondering do people have experience or know much on multi vessel stenting and bypass surgery.
My dad went for a stress check up and it was decided he would be best to have more tests. A angiogram was done and noted his LAD left main artery has 80% blockage/narrowing right where it branches of to others.
I had his cardiologist offer to options of multivessel stenting (2stents) to be done or bypass surgery. Due to covid 19 there is huge anxiety around my dad catching it and die to surgery not been able to fight the virus. So we are aiming for the multivessel stenting. However amongst this he has a cardiothoracic surgeon saying he feels bypass would be better for him. So 2 different views very conflicting. When asked cardioligist what advice or do you think is best his reply was stenting but he said if you asked the cardiothoracic he would say bypass.
This has now left my dad who is alone in hospital due to covid to make a decsion with helpt from us his family from phone conversations with him and cardiologist.
Is this normal in this type of treatment where the decsion is uo to patient self?
We are so post and confused as we want to make sure he gets the best treatment.

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Hi Cathy. I was at 90% on the LAD about ten years ago. My surgeon went with multi vessel stenting instead of bypass. after experiencing severe breathing problems in January, I underwent another cath only to find out that the two stents that were in my LAD had collapsed. So they re-opened them with two more new stents. I feel bypass would be a much better solution than to just keep stenting. When I mentioned this to the doctor, he said they won't do by pass for just one vessel (the LAD). If you can, go with the bypass. I think everyday what's going to happen next is I get another 90-95% blockage in my LAD.

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@racerjon and Cathy, I have had bypass twice and a total of 24 stents because my arteries keep plugging up with pasty and spongy dead proteins. The last stents place were done at Las Vegas, 14 of them, a decade ago, and they are still good. Since then I have had them reamed out a couple times, but no more bypass if I can avoid it. I am 80 now. My wife has been told several times I probably would not live through the night. Bt now my heart is giving me angina again, so who knows?

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You have done very well. You can live a long time with angina. Your heart has adjusted well to it's circulatory status. Perfection is the enemy of the good. Avoid going to any 'knife happy cardiologists". What did your cardiologist recommend and what has his experience been with survival or morbidity statistics. I know from experience that Mayo Clinic Cardiologists are superb, Ask him if you were a member of his family what would he do.. That has always been my gold standard.

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@oldkarl That's a lot of stents when I had my triple by pass in ,96 the Dr looked at stenting but my arteries where to small a balloon was tried but collapsed in 3 months so grafting from my leg was done I'm still here 24 yrs later

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There is a speech on youtube by Cardiologist Dr Aseem Malhota here


The scientific evidence is NOT to use stents on stable heart disease unless the patient has had a heart attack. But given that its the main artery and a heart attack would be known as a widowmaker, I would consider a bypass.

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@muscleriot

There is a speech on youtube by Cardiologist Dr Aseem Malhota here


The scientific evidence is NOT to use stents on stable heart disease unless the patient has had a heart attack. But given that its the main artery and a heart attack would be known as a widowmaker, I would consider a bypass.

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That's what I would like to have muscleriot. But I've been told several times that they won't do something as serious as bypass for just one vessel. They will only do it in a case of multi-vessel by pass. I though that there had to have been a time where multi-vessel bypass could have been done. It wasn't and out of the 18 stents I currently have, 4 of them are in the LAD.

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@peach414144

I have three stents in my iliac veins.since September 2018. Since then my legs from below my ankles and down four inches onto the foot and to about ten inches above the ankle have turned dark brown and are very painful and swollen. It is time to check if the stents are sill in the proper place and are still circulating properly. The cardiologist wants to do a cat scan with contrast. The endochronolgist says no contrast as it will be deadly for me with my problems. What next? Still waiting for cardiologist to figure out what other way can be used to see if the stents are in place and working. (This cardiologist was not the person to put the stents in place.) I think I have made a very poor decision in having the stents placed into my body. (Sometimes we grasp at straws to continue to live.) I feel stupid and shamed at what I have done for to remove the stents at age 82 is a deadly procedure. It is embarrasing to write this but maybe it will help others to think ten times before doing this. Be kind don't yell at me. (Perhaps some one should talk (yell) to the doctor who told me to do this procedure). Anyway still smiling.

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Hi Peach. Once the stents are in, they're in. If you do not have a bachelor's degree in a science, passed the MCAT exam, went to four years of medical school and can verify a five to seven year general surgery residency, there is no need to feel stupid and ashamed. First, those stents may have saved your life without you even knowing it. Second, you need to or have someone do it for you, to Tell this doctor YOU NEED AN ANSWER NOW. Nobody is going to yell at you but someone needs to get an answer for you from the doctor. If he still balks, find another cardiologist ASAP.

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