Severe Coronary Artery Blockage: Treatment Options and Risks

Q: Severe Coronary Artery Blockage: Treatment Options and Risks

Hello： In the case of narrowing or blockage in all three coronary arteries, lifestyle modifications and medication therapy are fundamental and necessary. <br>This includes controlling hypertension, blood cholesterol, and blood sugar levels, as well as using antiplatelet medicatio

Three blocked coronary arteries?

Hello everyone, my father is 60 years old (I created this account for him to facilitate the review of his basic information by various doctors).
Recently, he underwent a cardiac examination at the hospital, starting with an MRI, which revealed some issues.
He was then referred for a cardiac catheterization, and they were already preparing to place a stent.
I only learned about this from my mother after the fact.
Upon visiting the hospital, I found out that my father has two arteries that are 99% blocked and a third one that is about 50% blocked.
His cholesterol level is 741, and his blood pressure is 101-181.
He has previously relied on traditional Chinese medicine for maintenance, has not exercised, and has had a somewhat unregulated lifestyle.

The doctor mentioned during the catheterization preparation that a stent would need to be placed, but my mother insisted against it at that time.
I suggested that at least they should complete the examination first, and after some discussion, the doctor was unable to persuade us.
The doctor also mentioned that my father is very lucky because, given the degree of blockage and the atrophy of his blood vessels, he ranks sixth in Taiwan for this condition, with the top five cases having already experienced myocardial infarctions.
I don’t fully understand this part.
Eventually, my father agreed to reconsider and decided to start with medication to observe the situation (I know that medication may not be effective anymore, and the doctor was very clear about that).
He was admitted for one night, and the next day a cardiac surgeon came to explain the situation.
The surgeon stated that the surgery is necessary, as any further complications could lead to severe outcomes, such as being in a vegetative state or sudden death.
My mother has been persuaded (perhaps she initially lacked information), while my father is currently in a state where he cannot communicate.
The doctor has emphasized that this cannot be delayed and that surgery must be performed as soon as possible.
My current concern is that it seems there is no way to convince my father to undergo treatment.
He feels that having a stent means he will be dependent on such devices for survival.
However, I want to express to him that if he suffers a stroke, it would be the same, and being in a vegetative state or unable to move would be even more painful.
But such statements feel too heavy, and I fear poor communication.
Is the cardiac catheterization and stent placement really that significant? There is also the option of open-heart surgery, which I believe my father has no other choice but to consider, but I am currently unable to persuade him, which is very distressing for me.

I would like to ask if the situation is truly as serious as the doctors say? Additionally, regarding the choice between stent placement or coronary artery bypass grafting (CABG), would cardiac catheterization be more appropriate considering my father's age? Are there differences in the potential complications between these two procedures? Some people say that after undergoing catheterization, one can live a life similar to that of a normal person, which raises many doubts...
Thank you for your help.

A Sheng, 60~69 year old female. Ask Date: 2018/07/13

Dr. Huang Yinghe reply Cardiology

Hello: In the case of narrowing or blockage in all three coronary arteries, lifestyle modifications and medication therapy are fundamental and necessary.
This includes controlling hypertension, blood cholesterol, and blood sugar levels, as well as using antiplatelet medications.
Surgical treatment options can be divided into two categories: percutaneous coronary intervention (PCI) with stenting or coronary artery bypass grafting (CABG).
As you mentioned, your father has narrowing in all three coronary arteries, with two of them nearly completely blocked, which is indeed a very high-risk situation that requires prompt intervention.
Simple medication therapy cannot immediately improve the vascular blockage, so your physician's recommendation for surgical treatment is currently the better option.

Regarding whether to perform stenting or bypass surgery, several factors can be considered.
First, in terms of treatment efficacy, both PCI and CABG can immediately improve cardiac blood flow, enhancing quality of life.
However, for long-term (over five years) vessel patency, CABG is generally superior, as patients who undergo stenting have a higher rate of restenosis requiring further PCI.
PCI with stenting typically requires only local anesthesia, which allows for quicker recovery, often returning to normal activities within a day.
In contrast, CABG requires general anesthesia and thoracotomy, which may necessitate a hospital stay of about a week, and there will be a scar on the chest.

In terms of costs, CABG is covered by health insurance, while drug-eluting stents or certain specialized materials for PCI may require out-of-pocket expenses.
In the case of three narrowed vessels, the cost of PCI could potentially exceed that of CABG.
Your father is 60 years old, which is not considered too old; however, the risks associated with surgery and anesthesia do increase with age.
From a long-term surgical benefit perspective, I also agree that CABG is the better choice.
Of course, if he is adamant about avoiding surgery, PCI with stenting can also be considered, although it comes with higher technical difficulty and costs, as well as a greater chance of restenosis.

I suggest discussing with your father and physician which aspects are most important to you, and then making a final decision together.

Reply Date: 2018/07/13

More Info

Understanding severe coronary artery blockage and the treatment options available is crucial, especially when it involves a loved one. Your father's situation, with two arteries blocked at 99% and another at about 50%, is indeed serious. The decision to proceed with treatment, whether it be stenting or bypass surgery, can be daunting for both patients and their families.

Severity of the Condition
Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. The severity of blockage in the coronary arteries can lead to significant complications, including myocardial infarction (heart attack) or sudden cardiac death. In your father's case, the 99% blockage indicates that the blood flow to the heart muscle is severely compromised. This can lead to ischemia, where the heart muscle does not receive enough oxygen, potentially resulting in damage or death of heart tissue.

Treatment Options
1. Coronary Angioplasty and Stenting: This is a minimally invasive procedure where a catheter is inserted into the blocked artery, and a balloon is inflated to open the artery. A stent is then placed to keep the artery open. This procedure is often preferred for patients with significant blockages, as it can quickly restore blood flow and alleviate symptoms like chest pain.

2. Coronary Artery Bypass Grafting (CABG): This is a more invasive surgical procedure where a surgeon creates a new pathway for blood to flow to the heart by bypassing the blocked arteries using a vessel from another part of the body. CABG is typically recommended for patients with multiple blockages or when stenting is not feasible.

Risks and Benefits
Both procedures have their risks and benefits. Stenting is less invasive, has a shorter recovery time, and can be performed under local anesthesia. However, there is a risk of restenosis (re-narrowing of the artery) and the need for long-term antiplatelet therapy to prevent clot formation on the stent.

CABG, while more invasive, may provide a more durable solution for patients with extensive coronary artery disease. It can improve survival rates in patients with severe blockages and can alleviate symptoms more effectively in the long term. However, it involves a longer recovery period and carries risks associated with open-heart surgery, such as infection, bleeding, and complications related to anesthesia.

Communication and Decision-Making
It is understandable that your father may have concerns about relying on a stent for his health. Many patients fear that they will be dependent on medical devices. However, it is essential to communicate the risks of not treating the blockages. Without intervention, the likelihood of a heart attack or stroke increases significantly, which could lead to severe disability or death.

Encouraging open discussions with healthcare providers can help alleviate fears. It may be beneficial for your father to speak directly with the cardiologist or surgeon about his concerns. They can provide detailed explanations of the procedures, the risks of not proceeding with treatment, and the expected outcomes.

Conclusion
In conclusion, your father's condition is serious, and timely intervention is critical. Both stenting and CABG are viable options, but the choice depends on the specific circumstances, including the extent of the disease and overall health. Engaging in a thorough discussion with his healthcare team can help clarify the best course of action. It is essential to weigh the risks of the procedures against the potential consequences of leaving the blockages untreated. Ultimately, the goal is to improve your father's quality of life and reduce the risk of life-threatening events.

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