Multi vessel stenting vs bypass surgery

Posted by cathysudlow6 @cathysudlow6, May 2 1:55pm

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.

@cathysudlow6 Welcome to connect . We aren't Dr,s but are here to help if we can . Back in 1996 I had a triple by pass. I had 85,90,95 % blockage . I never have had any heart problems never on heart medicine Back then the cardiologist didn't mention multi vessel stinting . So mine was grafts from my leg . Good luck with whatever you decide for your Dad .Im surprised if he has the covid virus that they are considering surgery . PLease let us know what you decide and how your Dad is . We care here on connect

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Hi @cathysudlow6, this is such a difficult time with COVID-19 to be a caregiver and to make health decisions with your father. Of course, you want the best for your dad. With a quick Internet search, I found several research studies that showed similar clinical outcomes between stenting and surgery. So how do you chose when you have differing opinions from 2 medical professionals?

I'm also tagging @danab @thankful @miracleman and @heartbreaker to join this discussion to offer some thoughts.

Cathy, while COVID-19 is preventing you from being with your father in the hospital, keep in mind that the hospital is doing everything to make your father's environment safe and virus free. Is it possible for you to get a third opinion? Is Mayo Clinic an option for your father?

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@colleenyoung

Hi @cathysudlow6, this is such a difficult time with COVID-19 to be a caregiver and to make health decisions with your father. Of course, you want the best for your dad. With a quick Internet search, I found several research studies that showed similar clinical outcomes between stenting and surgery. So how do you chose when you have differing opinions from 2 medical professionals?

I'm also tagging @danab @thankful @miracleman and @heartbreaker to join this discussion to offer some thoughts.

Cathy, while COVID-19 is preventing you from being with your father in the hospital, keep in mind that the hospital is doing everything to make your father's environment safe and virus free. Is it possible for you to get a third opinion? Is Mayo Clinic an option for your father?

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Hi Lioness and Coleen thank you for your reply's.. I am living in London and my dad is in Ireland in hospital. It is a difficult time to try and communicate it's not thr same over a phone as talking with the cardiologists or cardiothoracic surgeon plus so much harder when they both have different opinions and those been quite different!!
I am trying to see if I can get another cardiologist to give another opinion. Sorry he is not positve for covid 19. We are just worried that having the bypass surgery he may be high risk of getting thr virus and feel it would be a dangerous time as not sure he would fight it..to say that my is young 65 this year…just wondering has some people had experience of multivessel stenting with LAD artery damage at 80%.
Thank you all 🙂

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@lioness

@cathysudlow6 Welcome to connect . We aren't Dr,s but are here to help if we can . Back in 1996 I had a triple by pass. I had 85,90,95 % blockage . I never have had any heart problems never on heart medicine Back then the cardiologist didn't mention multi vessel stinting . So mine was grafts from my leg . Good luck with whatever you decide for your Dad .Im surprised if he has the covid virus that they are considering surgery . PLease let us know what you decide and how your Dad is . We care here on connect

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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 @cathysudlow6 I also welcome you to Connect, I have personally not had this type of surgery but being a heart transplant patient I am familiar with open Heart Surgery. I do know that any open chest surgery I would say is more invasive than putting in stents. The recovery I do know is longer with open heart verses stents. My pastor as a matter of fact has had 3 stents put in in the past few months and the recovery was quick and he is already back Preaching again. actually his recovery was like a week. With me it was 6 weeks before I was doing much without pain meds and then Cardio rehab for 26 weeks. So i would say if the Stents are a option than go that route first. Plus the other thing is with open Heart the infection risk is higher than with stents. I am not a doctor so please know I don't know all the risks for either surgery so that would probably be my first question as to what other risks are there with either methods and the percentage of success. I hope that helps.
Have a Blessed Day
Dana

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Get an opinion at Mayo or from Mayo even via distance if you can. Then get it done at Mayo if you can.

I was facing the same question/different advisement from different doctors (similar to what you wrote), and I was given the advice to go to mayo from a friend. I also had other complications and variables. This was before covid. I did go to mayo and after it was determined I did need/get bypass.

Every situation is different so I am not saying what he may need. Just saying how he can find out. If not possible maybe consult another opinion. Good luck.

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@cathysudlow6

Hi Lioness and Coleen thank you for your reply's.. I am living in London and my dad is in Ireland in hospital. It is a difficult time to try and communicate it's not thr same over a phone as talking with the cardiologists or cardiothoracic surgeon plus so much harder when they both have different opinions and those been quite different!!
I am trying to see if I can get another cardiologist to give another opinion. Sorry he is not positve for covid 19. We are just worried that having the bypass surgery he may be high risk of getting thr virus and feel it would be a dangerous time as not sure he would fight it..to say that my is young 65 this year…just wondering has some people had experience of multivessel stenting with LAD artery damage at 80%.
Thank you all 🙂

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@cathysudlow6– Hello Cathy! I had a HA back in 2014 and my LAD was 100% blocked and the Cardiologist chose to do a stent vs. open heart surgery. My thought is that stenting has become so much more prominent because it is far less invasive than open heart and the recovering time is so very quick. I'm sure there are times when open heart is more prudent because of the complexity, but I'm not a Dr. so I can't speak to that. In the interest of the times we find ourselves in and your concerns about your dad possibly being able to fight off the Covid-19 or as my daughter tells her young daughter (the big sick) I would favor the stenting.
If you could get a second opinion that would be awesome so I would recommend that if possible.
I have a cousin in Dublin that just retired from being an ER nurse at Beaumont hospital in Dublin. She is terible about returning my emails, but I will give it a go and see if she could make a recommendation of a Cardiologist and so if I hear back I will post what she says. All my best! Jim@thankful

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I had 85% blockage on left descending main artery just before the branch. I was told in 2003 that it was too close to the branch to stent and ended up with bypass surgery. 5 bypasses done. Surgery done at Mayo in Eau Claire in 2003. I've been on blood pressure meds, beta blocker and ACE inhibitor and statins ever since. No major issues since surgery.

Liked by lioness

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Hello @ronmehr and welcome to Connect. Sorry to hear about your 5 bypasses, but glad you have been issue free since the surgery. Can you lend any advice to others on your recovery? It sounds like your surgeon didn't give you a choice, that you had to go with the bypass.

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@ronmehr

I had 85% blockage on left descending main artery just before the branch. I was told in 2003 that it was too close to the branch to stent and ended up with bypass surgery. 5 bypasses done. Surgery done at Mayo in Eau Claire in 2003. I've been on blood pressure meds, beta blocker and ACE inhibitor and statins ever since. No major issues since surgery.

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@ronmehr Congrats with 5 by passes . I had 3 in 96 So eating right and exercise is the trick for us . I, only on blood pressure and statin meds

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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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