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Diabetic have Coronary artery disease. Had stent placed in arteries and had pacemaker implanted. Now artery occluded. Suggest?

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I am XXXXXXX active 65 yr. old male with CAD(10yrs) and type one diabetes(30yrs). I had four stents placed in my circumflex arteries about 10 years ago and recently underwent a cardiac XXXXXXX prior to having a pacemaker implanted.
Th e XXXXXXX showed my right coronary artery to be 80% occluded in two places. My cardiologist thinks if the artery were stented it would be very likely my angina would lessen or disappear altogether. I am less optimistic about this because of symptoms wich reoccured 1 year after my last stents ten years ago.
Posted Thu, 19 Sep 2013 in Hypertension and Heart Disease
Answered by Dr. Sukhvinder Singh 26 minutes later
Brief Answer:
Both of you are correct, please see details....

Detailed Answer:
Dear Sir
1. If you have angina on exertion (chest heaviness/ discomfort) that relives by rest; I mean if you really have anginal symptoms and you have significant blockade only in right coronary artery (no other artery having >70% stenosis), then likelihood of getting relief after the stenting is high (provided that stenting is feasible). {I hope your left sided arteries do not have significant occlusions.}
2. If there are significant occlusions in other arteries too, the angina may not be relieved completely or significantly.
2. Yes, no one can assure you that your symptoms will never come again in future but that's the way this disease is. A person, after stenting, can have re-blockade at site of stent or can have new blockades in same or different arteries. Hence can have angina gain. At times, especially in diabetic hypertensive patients, the angina may be because of smaller arteries involvement (although that carries a better outcome & does not require stenting).
Hope this provides some insight into the problem.
Feel free to discuss further.
Sukhvinder Singh
Above answer was peer-reviewed by
Follow-up: Diabetic have Coronary artery disease. Had stent placed in arteries and had pacemaker implanted. Now artery occluded. Suggest? 20 minutes later
When i had my circumflex artery stented in 4 places early in 2004, one year later the exact same symptoms occurred while I was running. However even now those stents are completely open so I am wondering how one knows those really did any good or whether there is another cause. I saw a non-interventional cardiologist right after the symptoms re-occoured in 2005 and he did a pet scan and found no serious blood flow issues. His theory was that because of the aging issue plus the diabetes role in making vessels less elastic that the heart was more than capable of pumping blood needed for running, but the rigid vessels coul not open suffeciently to deliver the blood to extremities. this theory made sense to me and that is why I am less confident about stenting of the right artery alleviating my angina. Are you familiar with "accelerated plethsmograph" and "arterial elasticity" tests. If so, what do you think about the efficacy of undergoing these tests. from the little I have read they seem to be non-invasive.
Answered by Dr. Sukhvinder Singh 17 minutes later
Brief Answer:
please see details below.

Detailed Answer:
Respected Sir
1. Your cardiologist in 2005 said exactly what I told you in last paragraph. The elasticity is reduced and the ability to dilated in response to exercise is gone. This happens in smaller arteries (microvascular angina) and is neither amenable to stenting nor it is as XXXXXXX as major vessel occlusion.
2. There are both invasive and non-invasive methods to look into the issue. If routine stress test (TMT, exercise ECG, Exercise ECHO or stress thallium) shows abnormality with mimicry of anginal symptoms but angiogram is normal, one can suspect small vessel disease to be responsible. But if the major vessel abnormality is there, one can check in XXXXXXX lab and look into certain parameters like FFR (fractional flow reserve) and other parameters to ascertain the significance of stenosis and contribution of small vessel disease.
3. No, I am not using arterial plathysmography in patients of coronary artery disease and to the best of my knowledge it is not recommended by governing bodies also. These test will be conducted on peripheral arteries and not on coronaries and can not be taken as a true surrogates for coronary disease.
4. In nutshell, your interventional cardiologist can go for physiological testing (FFR etc.) during coronary angiogram to ascertain the significance of lesion and can decide accordingly.
Hope this helps. Feel free to discuss further.
Sukhvinder XXXXXXX
Above answer was peer-reviewed by
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