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Old 05-16-2011, 07:03 AM   #1
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Should we do a 2nd angiogram after stent operation?

Hello

I'm asking this for my dad and we'd appreciate if anyone's able to give some advice.

My dad's 63 this year, in 2006 when he was 58 he started experiencing chest discomfort (a feeling of pressure in the chest when walking fast, breathing difficulties after heavy meals). After putting him through the stress treadmill, the doctor did an angiogram and put a stent in after finding 95% blockage in an artery.

It's been 5 years and he doesn't feel those symptoms anymore. He also did another stress treadmill last year and was in the normal range. I have to add that during this period he's exercising more regularly, lost weight, and been taking statins, aspirin, dilatrend and approvel. (His cholesterol levels are usually within the higher end of the normal range, but his diabetes readings are usually a little higher than normal)

His doctor wants him to do a second angiogram to check how the arteries are now. The doctor's saying that, although he feels no symptoms, that's the only way we can be sure he's ok. I'd like to ask: is it standard practice, or even necessary, to do this?

Thanks.

 
Old 05-16-2011, 07:59 AM   #2
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Re: Should we do a 2nd angiogram after stent operation?

I can give my perspective based on my experience. About 7 years ago I was hospitalized for congestive heart failure. My RCA was stented due to 98% blockage, the LAD was/is totally occluded and the ICX was 72% blocked with no intervention. I do not have any problems with medfication and my non-interventional cardiologist has never suggested I get the ICX stented.

Normally, it would not be necessary to examine the cardiovascular system unless there are symptoms. But if one has diabetes and occlusions of arteries there may not be any symptoms. It seems to me a stress test would show any occlusions with the perfusion of the vessels. Although, there is a slight risk with the intervention analyzes it should not be given when one doesn't have systems, other relevant tests are negative, etc.

My doctor has me take an echocardiogram periodically. I have had a stress and CT scan 64 slice angiogram. Tests show I have some occlusions and the ct scan shows some cholesterol buildup in between layers of the vessel.(complete anatomy of the vessel from the Lumen (inside vessel) to the outer layer of the vessel.

You may want to get a second opinion from a non-interventional cardiologist...I don't believe based on your information it is necessary to get another cath angiogram. If the stress test had shown some perfusion defects then a cath my be introduced with the expectation of a strong possiblity a stent would be implanted.

The COURAGE study provides a guideline for intervention to only stent occlusions greater than 70% if there are SYMPTOMS. All therapy (medication, stent, bypass) only treats the symptoms there are no cures and none of the 3 interventions affect longivity.

KenKeith

Last edited by started04; 05-16-2011 at 08:02 AM. Reason: dropped word

 
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Old 05-17-2011, 12:09 PM   #3
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Re: Should we do a 2nd angiogram after stent operation?

I had a 95% blocked LAD that was found on my cardios echo stress test, this guy is supposed to be one of the best in NY State ! 7 months later a follow up echo stress test and run to alomost ma heart rate for extended period, he told me " not even a glitch " he feels as long as no symptoms and echo stress looked great im fine no need to do any more invasive tests

 
Old 05-20-2011, 08:19 AM   #4
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Re: Should we do a 2nd angiogram after stent operation?

Thanks for your replies!

It sounds like my dad shouldn't be going for another angiogram unless he starts to experience symptoms again.

But KenKeith, do you mean that since my dad has diabetes at the same time, he may not experience symptoms of occlusions even when there are occlusions?

Comparing CT scan, echocardiogram and angiogram, am I right to say the angiogram is the most accurate when it comes to looking for occlusions or blockage?

Thanks so much again. Your replies are really helpful to us.

 
Old 05-20-2011, 09:37 AM   #5
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Re: Should we do a 2nd angiogram after stent operation?

Quote:
Originally Posted by brenda22 View Post
But KenKeith, do you mean that since my dad has diabetes at the same time, he may not experience symptoms of occlusions even when there are occlusions? .
American Heart Association: "Evidence accumulated in recent years demonstrated that asymptomatic myocardial infarction (silent heart attack) or asymptomatic myocardial ischemia (silent ischemia) occurs more frequently in diabetic patients. In fact, the Framingham study reported that in diabetic patients, the incidence of painless myocardial infarction was higher than that in nondiabetic patients. Other studies also demonstrated that in diabetic patients, the incidence of painless myocardial infarction is higher than in nondiabetic patients."

Take care, I wish your father well going forward.

 
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