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Angiogram showed blockage. Advised to do angioplasty and kidney biopsy. Is smoker and drinker. Future risk?

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Cardiologist, Interventional
Practicing since : 1998
Answered : 424 Questions
Hello Doctor,
My uncle underwent angiogram and was diagnosed to have 90% block in this right artery. Angioplasty was advised. However as his urine creatinine level is 1.8 mg/dl, angioplasty is differed and further kidney biopsy test is advised. We are yet to receive the biopsy result. In the mean time I want to get a second opinion here. My uncle never felt any pain in the heart and had only minor burning sensation when he got the first attack. With this symptoms can the diagnosis of having 90% block be true? Or should we insist on any more tests and finding before proceeding with further treatment? What are the complications and risks he has got during the procedure and in the future? He is a smoker and drinker. But never had any previous illness.
Posted Tue, 14 May 2013 in Hypertension and Heart Disease
Answered by Dr. Prabhakar C Koregol 41 minutes later
It is possible for people to have critical blockages without having symptoms and they suddenly become manifest in the form of heart attack or can get detected by the TMT test. Angiogram is the gold standard for the diagnosis of the coronary artery disease, if done and interpreted by well trained cardiologist and shows 90% lesion it means it and has thereupatic implications. You dont need any further tests. Also symptoms can very very minor pain to severe pain and some times one can develop a heart attack and dont feel any symptom of it. (Silent heart attack).
I dont understand the reason for the renal biopsy, as for contrast induced raise in creatinine we do not advice the biopsy.
If it can fixed by angioplasty he can under go the same once renal issues are sorted out.
Angioplasty with stent has some immediate complications and late complication. Immediate complications include
1. Renal failure
2. heart attack generally minor
3. Heart failure especially if his heart has become weak due to previous attack
4. Rare complication such as perforation, embolism
5. Complication of acess site such as infection and bleeding.
6. Hemorrage complications due to anticoagulants
7. Very rarely it can carry life risk as well.

Late complications include
1. Instent restenosis or recblockage in same artery
2. Stent thrombosis occasionally (Blood clot formation) which can lead to heart attack.
Above answer was peer-reviewed by
Follow-up: Angiogram showed blockage. Advised to do angioplasty and kidney biopsy. Is smoker and drinker. Future risk? 16 hours later
Hello Doctor,

Thanks for the detailed response. I would like to know some more details on this please.

I understand that 90% blockage is in the Obtuse Marginal Artery and not in the the main artery. Though I understand that this is a problem, I want to know whether this has life threatening risk. This will help in deciding whether we can differ the treatment for few months until his renal issues are sorted because his creatinine level was 1.6mg/dl even before angiogram and after angiogram it increased to 1.8mg/dl.

Because of the complications in angioplasty, I would like to know other alternative treatment for this. I heard about Artery Clearance Therapy (Chelation Therapy) to be effective in treating this and is widely practiced worldwide. What should I consider before opting for this treatment? Does this therapy too have any side effects or complications?
Answered by Dr. Prabhakar C Koregol 18 hours later
It depends on the size of the artery and amount of the heart muscle involved. So weather it can be differed or no - can be decided only by the cardiologist seeing patient and angiogram CD. Therefore you will have to discuss with your cardiologist.

You don't have have to wait weeks for the creatinine to become normal, in fact with few precautions even at 1.6 -1.8 we can be able to PTCA, if its urgent and essential.

Chelation is hyped but not established therapy and wouldn't recommend it your case. Though angioplasty has so many complications it occurs very rarely and still remains a very safe treatment option.

Hope I have answered your query. Let me know if you need clarifications.

Above answer was peer-reviewed by
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