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Erskine please help

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Posted 2/25/2006 4:16 PM (GMT -6)
I am scheduled for stenting of the "very proximal Lad", 70% occluded, this Thursday. I have a "very short L main". This is in my patient notes below under the old thread.

I am having really bad chest pain and should have been hospitalized this past Thursday, after the angiogram. I have increased my Imdur and use of fast nitro, in an attempt to limit damage to my heart muscle, while I look at my options. I could go to the Cleveland Clinic for the new "keyhole bypass surgery". I just read where attaching the mammary gland artery to the proximal Lad is one of the CAD conditions, best suited for this surgery.

I also have this info:

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The present study suggests that patients with multiple vessel disease and severe stenosis of the proximal LAD can be effectively treated with either PCI with liberal use of stents or CABG. Although the number of patients in this subset analysis of the ERACI II trial is small, at long term follow up both revascularisation strategies had similar survival, survival with freedom from non-fatal myocardial infarction, and completeness of revascularisation. Thus, both strategies seem equally safe and effective in improving the clinical status of these patients.

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This article does not discuss having a very short left main and it's outcome on stenting.

I believe they are going to do CABG Thursday, instead of stenting. The doctor said "he was agreeable to try" stenting. I am obsessing on this, no I have passed that point...., and it has a snowball affect on the chest pain. I am very desperate at this time. I would very much appreciate any insight you could give. Thanks so much in advance,

RJ

Posted 2/25/2006 7:37 PM (GMT -6)
RJ,

Sorry I did not respond before this. I am taking a cardiac MRI class in St. Louis during the week, so am traveling every weekend and did not see your postings until today.

I do not know much about this new Cypher stent, so I cannot comment on it. The Cypher stent is very similar to the Taxus stent, but I do not know much about the "junction" Cypher stent or whatever they are calling it.

History of proximal LAD/left main stenting. Back when angioplasty/stenting were just getting started, tehre were fairly often (10-20%) of the time complications at the stent site--which would cause acute closure of an artery. If this happens in the RCA or the circumflex, it causes a heart attack, but the patient would live--if it happened in the proximal LAD or left main, that was pretty much a death sentence. So when patients had proximal LAD or left main disease, they got bypass. However, now that stents are better with decreased complication rates, we are stenting more proximal LAD's and left mains. (In case you have not figured it out yet, we cardiologists have a bit of an ego--anything a surgeon can do, we can do better.)

So my advice to you (and again, this is not treating you--just my advice from the material you have given me), have the stent--should keep the areas safe from restenosis. If there is a complication, then you can get the internal mammary artery to LAD as a backup plan. One of the worst things I see is when there is some flow in the LAD and they attach a mammary--the competitive flow from the LAD makes the mammary look even worse.

Just my 2cents (although I still wonder if it is worth that).
Posted 2/25/2006 9:51 PM (GMT -6)
G-d bless you :) I am so glad to hear your advice. I am feeling better tonight. I think I will have my daughter drive me to UAB University hospital tomorrow, and enter the ER there. I have seen a very good cardiologist there about 1.5 years ago. The press has it that UAB has some of the best Cardios around these parts. I am going to take me cd with me :) I just don't trust the guys in Huntsville. I told the head nurse last Thursday that I was having angina very bad, and to please hand me my nitro (couldn't move my leg after the cath), and that I had been awakened by strange heart pain and bad angina, 2 times. He said if you need that you won't get to go home. I said ok. It probably would have meant extra paperwork for him. It was an outpatient deal and I was the last to leave.

Good luck on your training :) I guess you guys do get extra, but do you get a big quiz afterwards? Ha ha ha.

Thank you so much. Your words mean a lot. More than you will ever know. Now get some rest or party in St. Louis!!!!!!!

RJ
Posted 2/26/2006 6:39 AM (GMT -6)
UAB probably does have some of the best in the Southeast. Good luck at UAB.
Posted 2/26/2006 8:39 AM (GMT -6)
Oh RJ I am sorry that you are having problems!!  Please keep us updated....  My thoughts are with you :-)
Posted 2/26/2006 9:54 AM (GMT -6)
Thanks Elisha and Doc :)

I am feeling much better today, so far. Thursday afternoon, night and Friday were a nightmare for me. I have never dealt with such angina before. It is much better now and I do not know why, nor do I care, lol. I am not going to Birmingham today. It is 100 miles away. I may talk with someone there tomorrow, about having the procedure there. Huntsville has at least offered their stent "expert" to do this, so, I don't know.

I do hope that you and all of our members here are feeling as well as possible. Big Bama hugs to all :)

RJ
Posted 2/26/2006 10:46 AM (GMT -6)
:-)  glad your angina has been releived, try not to get too stressed, that really does make it worse doesn't it. we will all be waiting to hear how things go. i agree ersk really brought it down a couple of notches from what you were imagining, good job erk!!!!
Posted 2/26/2006 7:59 PM (GMT -6)
Dgirl I have no promises that my blockage can be stented. I'm almost sure that Erskine is aware of this also. While on the cath table the doctor told me that the blockage was normally repaired by bypass surgery. I told him that I didn't want to have bypass surgery. He said it may could be stented. He left the cath table and phoned the stent expert. He came back and told me that the expert would attempt to stent the blockage. I realize that stenting may not work and I may have to have emergency bypass surgery. All I know for sure is that I cannot survive without repair of this blockage.

I hope you are feeling well,

RJ
Posted 2/27/2006 10:26 AM (GMT -6)
glad you cleared that up, that is worrisome. when i had my stents placed the dr. right then said i would be back in 5 years for a bypass, that was very scary, i do not know why he said that as my blockage was taken care of.  well now that i think of it i have a small artery that is not stentable that is 60% blocked and i think he was thinking of that, also my stents are close togehter and he said the plaque might build between them, so it really never ends does it,  be as at peace as you can, not preaching here just trying to lift your worry . i will check in later.
Posted 2/27/2006 1:02 PM (GMT -6)
Aldo, i'm so sorry your going through all of this, and i know your scared. Any one would be, and i should know. You have been a friend to all of us since you became a member of the HW and we will be here for you as you go thru these problems. It seems unfair at times for some to be so healthy and then us and others aren't, but we will win this battle. Some times when i read your posts i say to myself i wish Aldo would stop looking up all these ands and ifs then i laugh because when i first started having heart problems i did the same thing. So keep being that loving guy you are and i wish you all the best and i'll keep you in my prayers. With all the love i have, double hugs to you Aldo. DELTA
Posted 3/4/2006 10:55 AM (GMT -6)
eyes  we are waiting to hear from you Aldo? takes a sew days to recover, just know we are all here.
Posted 3/5/2006 8:13 AM (GMT -6)
I am worried about RJ too.  I hope they didn't have to do the bypass.  Hopefully we will hear from him soon. confused
Posted 3/5/2006 9:33 AM (GMT -6)
eyes  still no word from Aldo, bummer.how have you been doing? i have had a couple of great days.
Posted 3/8/2006 3:23 AM (GMT -6)
HI ALDO,IHOPE YOU ARE DOING WELL.I HAD QUAD.BYPASS SURGERY IN 2002 SO I KNOW IT IS VERY SCARY.MY PRAYERS ARE WITH YOU AND HOPE WE CAN CHAT FOR THE FIRST TIME SOON.
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