When is by-pass surgery necessary over a stent in the LAD?
A heart cath indicated that I had a 50%-60% blockage in the LAD artery. The cardiologist recommended a stent. A second opinion indicated by-pass surgery over the stent. Which is the most acceptable at this point?
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It sounds like you have done your homework and made a good decision for yourself, @normanturner525 .
Have you ever had any type of procedures before? How do you prepare?
I have a calcium score of 1160, is it risky for an 8 hrs travel? I am afraid of stent because my friend had failed kydneys affected by many meds taken after stent. He is now having regular dialysis. Any helping comments will be appreciated. Thanks
Hi @ssarevalo . Welcome to Connect!
This is my totally non-medical opinion…if you did just get this test and you are concerned about driving, please call your doctor and ask them. A high calcium score by itself will not make a difference, but certainly it depends on your overall health and what symptoms you have going on.
Test results like your high calcium score can be super stressful, particularly when they are the first piece of information gathered to provide a picture of your overall cardiovascular health. Your score is high and most definately, you will benefit from following up with a cardiologist. I imagine their recommendations will be to do further testing to understand your unique risk.
Here is a summary of the a calcium score test, what it means and what follow up looks like: https://www.webmd.com/heart-disease/coronary-calcium-scan
I went to the homepage a typed “calcium score test” in the box at the top. Here is discussion with others that also have high scores like yours: https://www.webmd.com/heart-disease/coronary-calcium-scan
What prompted you to get a calcium scan, were you having symptoms?
Do you have any symptoms?
Janell, my closest procedure to this was in August of 2019. I had a 3 stage neck surgery. It, like I expect this to be, was no fun in the recovery. But, I did get over it and I expect to recover from this, but it will take so long and have some things I need to do and some I want to do. However, it is what it is.
Hey - I can totally relate to your situation with the treatment decision regarding your Left Main Coronary Artery (LMCA). I too have just learned from Mayo after my Angiogram that my LMCA has a blockage at the bifurcation of just over 50%, and the recommendation is CABG versus angioplasty and stenting. I also have a 70% blockage in my right coronary artery, and 60% in my first LAD D1 branch.
We are a part of a smaller percentage of people with CAD that have LMCA stenosis. Most people (roughly 90%) do not, and their concerns typically revolve around the LAD because it's called the "widowmaker". The LMCA is actually the widowmakers widowmaker in a way, because it's the MAIN artery that feeds the LAD downstream, so that is why it has a revascularization cutoff of 50% versus the 70% cutoffs for other blocked vessels.
Most treatment modalities indicate CABG for LMCA stenosis because of this, but factors like the lesions location (ostial, distal, proximal), it's length and characteristics, is it at the bifurcation, FFR and IFR values, surgical candidacy...etc, play a role in how it's approached. If it's complex for stenting, multiple vessel disease, and you're a good candidate for surgery, the best long term outcomes historically lean towards CABG versus PCI, and that's why it's the common approach to it, but some situations can make stenting the left main feasible.
I feel for you, man. This came out of left field for me while being screened for something unrelated. I have no angina, haven't had a heart attack or cardiac episode, did fine on my stress echo, and my worse symptoms are some shortness of breath under exertion - so it's tough to face this choice for CABG surgery. I am scheduled for July 2nd at Mayo Rochester since I live 2 hours from there, but I have an appointment with an interventionist just to cover my bases and reconfirm that angioplasty isn't a viable option for me. I'm 57, and have never had a surgery - so this is pretty intimidating to wrap my head around. My surgeon said it would be three vessels bypassed for me.
Were you having symptoms like angina? Did the interventional cardiologist who did your angiogram explain why they didn't stent anything when they were in there?
Hi @brique , and welcome to Connect! I see you and @normanturner525 have something in common here.
Is your interventionist at Mayo as well? You mention surgery July 2, how long will you be in the hospital?
Hi @jlharsh - yes, we have the uncommon in common for sure with the LMCA blockage. It's a prize nobody want's to win! Matter of fact, if I didn't have that LMCA involvement at just over 50% my treatment plan would have likely been a stent in my RCA during the cath, and medications alone with regular watching for future blockage in my LAD - but since there is a need to CABG bypass the LMCA the Interventional Cardiologist left things alone so as to not complicate CABG surgery, and leave the RCA and LAD for bypass at the same time.
Yes, the Interventionist who did my cardiac catheter angiogram is at Mayo in Rochester, and the Interventionist I am meeting with on Monday is too. I have had Mayo as my primary care provider in a satellite clinic since 2022, so I didn't require a referral for care. As far as the hospital stay for my surgery, barring any complications or longer recovery needs (knock on wood), it was relayed to me it's a couple days in ICU post-surgery, then 5-7 days in the hospital itself.
I can relate with @normanturner525 on the need/want to get some things done beforehand. It's tough electing for a procedure that is more prophylactic than relieving symptoms, but with the information that so much risk is at play should an adverse event occur, you feel like you're left with no choice. It's a rock and a hard place for sure.
I am in the same boat. I am symptom free and stable. I am now looking at quadruple bypass (three on left, including LAD and one on right). And since the surgeon will be in there, he also will be repairing two dilations on my aorta (Modified David Procedure). I am having tough time getting my head around this too. Just seems surreal to me. Doctors have told me that I can still exercise too, at a slower pace. Trying to do that, but it's tough mentally.
My surgery is set for July 10 @ Northwestern.
Best of wishes for your surgery!
Yeah, surreal is well put. Trading possible future risk for risk now is definitely a head game. The knowledge you're walking about with a serious cardiac condition, coupled with the stressor of an upcoming major surgery leaves little space for mental peace. I won't lie, there has been plenty of denial and a temptation to lessen the situation in my mind in order to delay what seems unavoidable....but then I read the stories of those that had their procedures done in an emergency situation, or had such a severe acute cardiac event they didn't survive or were left with extreme morbidity, and it brings me right back to reality that catching this now was fortunate.
I'm hoping there are some people that have had the LMCA situation and had either CABG or stenting that will chime in.