stents vs bypass surgery

[deeoeraclea]

For a few months, I have been feeling tightness in my chest when walking up hills. So, I decided to have a stress test done (first step was actually and ECG, which was normal). After doing the stress test, rather than sending me home, a cardiologist entered the room and told me she though I should be admitted to the ER, as my stress test was abnormal. Upon being admitted to the ER, they sent me to the cath lab, where they found partial blockages in three arteries leading to the heart. The recommendation now is to either have stents put in to open the blocked arteries or have a bypass operation.

Putting stents in is a very simple procedure, which can be done without a hospital stay, and which would allow me to return to full activities within just a few days. The bypass, on the other hand, is a major operation, which would be done under general anesthesia, require a 5 day hospital stay, and which would take months to recover from. So, all else being equal, the stents seem like a much better option -- both because of the shorter recovery and the lower risk of complications during the procedure.

But, the surgeon I spoke with said that, because I am young (42), the bypass would be a better option, as it has a superior long-term outcome. I'm not sure exactly what that means. But, what I think I gathered is the bypass is far more likely to be a one and done thing, whereas the stents may require further stents in the future, which doesn't seem so bad, given how simple the stent procedure is. But, I think there may be some limit to the number of times one can put in a stent before all bridges have been burned.

Anyway, all of this is just to ask: do any of you have strong opinions on which of the two options (stents or bypass) is best for a young male that wants to remain active? Any information you can provide or resources you can point me to would be appreciated.

 

[sushak]

For a few months, I have been feeling tightness in my chest when walking up hills. So, I decided to have a stress test done (first step was actually and ECG, which was normal). After doing the stress test, rather than sending me home, a cardiologist entered the room and told me she though I should be admitted to the ER, as my stress test was abnormal. Upon being admitted to the ER, they sent me to the cath lab, where they found partial blockages in three arteries leading to the heart. The recommendation now is to either have stents put in to open the blocked arteries or have a bypass operation.

Putting stents in is a very simple procedure, which can be done without a hospital stay, and which would allow me to return to full activities within just a few days. The bypass, on the other hand, is a major operation, which would be done under general anesthesia, require a 5 day hospital stay, and which would take months to recover from. So, all else being equal, the stents seem like a much better option -- both because of the shorter recovery and the lower risk of complications during the procedure.

But, the surgeon I spoke with said that, because I am young (42), the bypass would be a better option, as it has a superior long-term outcome. I'm not sure exactly what that means. But, what I think I gathered is the bypass is far more likely to be a one and done thing, whereas the stents may require further stents in the future, which doesn't seem so bad, given how simple the stent procedure is. But, I think there may be some limit to the number of times one can put in a stent before all bridges have been burned.

Anyway, all of this is just to ask: do any of you have strong opinions on which of the two options (stents or bypass) is best for a young male that wants to remain active? Any information you can provide or resources you can point me to would be appreciated.

I don't have anything to add to help in regards to your questions but it would be cool if you could expand on how you got into this situation, was it through ped use, lifestyle/weight or some hereditary issue? 42 is so young!

 

[deeoeraclea]

I had very high LDL (~400 mg/dL) from the ages of 23 - 40 and did nothing about it. I figured that, since i was lean, ate a healthy diet, and exercised regularly, I had nothing to worry about. I had a coronary calcium scan done two years ago, and found that I had a score of about 35, which is not high, but it should have been zero at my age. At that point, I got serious about lowering my LDL. Presently, I am on Rapatha (a pcsk-0 inhibitor) and Zetia. My LDL has been in the normal reference rage for a while now. But, you can't undo 15 years of plaque build-up after it happens.

That said, I was surprised to find that I had a partial blockage now, given the calcium CT scan I had just a few years ago. Part of me wonders if 3 doses of the Pfizer vaccine caused a problem. But, even if it did, nothing I can do about it now.

I very much doubt the 140 mg/week of testosterone I am taking had any affect. In fact, my cholesterol went DOWN after getting on testosterone.

 

[bigMoJo]

Difficult and tough situation... but man, you are lucky to be alive! Let's be happy about that! Also, at least you can decide stents or bypass.

Heart disease runs in my family. My dad had a heart attack at 50, but survived with angioplasty. Later received two stents. My cousin had bypass. However, his was a situation like yours... but, they made him stay and bypass was the only option. He's not an athlete or a lifter. So, I don't think he ever thinks about it.

In your case, I think the cut on the chest bone for a bypass would take alot out of you (you know this)... making recovery lengthy, and training possibly more difficult in the future. It may interfere with your quailty of life. I think your angle on the stents is right.

Although, I don't like when a doctor doesn't inform me enough to where I feel there was a lack of information. As you said, you're not sure about the "one and done" and so on. Definitely get a second or third opinion if you have time. It's sad to say, but we have alot of doctors that are full of sh**.

Your thought process on all this seems very sound. Please share how things progress. Wish you the best and a long and healthy life.

 

[dontletheoldmanin]

For a few months, I have been feeling tightness in my chest when walking up hills. So, I decided to have a stress test done (first step was actually and ECG, which was normal). After doing the stress test, rather than sending me home, a cardiologist entered the room and told me she though I should be admitted to the ER, as my stress test was abnormal. Upon being admitted to the ER, they sent me to the cath lab, where they found partial blockages in three arteries leading to the heart. The recommendation now is to either have stents put in to open the blocked arteries or have a bypass operation.

Putting stents in is a very simple procedure, which can be done without a hospital stay, and which would allow me to return to full activities within just a few days. The bypass, on the other hand, is a major operation, which would be done under general anesthesia, require a 5 day hospital stay, and which would take months to recover from. So, all else being equal, the stents seem like a much better option -- both because of the shorter recovery and the lower risk of complications during the procedure.

But, the surgeon I spoke with said that, because I am young (42), the bypass would be a better option, as it has a superior long-term outcome. I'm not sure exactly what that means. But, what I think I gathered is the bypass is far more likely to be a one and done thing, whereas the stents may require further stents in the future, which doesn't seem so bad, given how simple the stent procedure is. But, I think there may be some limit to the number of times one can put in a stent before all bridges have been burned.

Anyway, all of this is just to ask: do any of you have strong opinions on which of the two options (stents or bypass) is best for a young male that wants to remain active? Any information you can provide or resources you can point me to would be appreciated.

Hello there,
Sorry to here about your issue I'm sure it's be stressful.
I currently have a popliteal aneurysm (right leg middle thigh area) it's 3.5cm borderline i could live with it it opt for surgery....
Give me age (49) I've decided to not go the stint route and just get the bi pass done, why?

Well at my age is won't be healing fast as actually as I age I heal slower and most of us know this.
Also no matter how healthy I live or try to keep living it will always be there in my mind casuing stress, thus it's much better to just get it delt with and over with as much as it can be and then heal.

My choice would get me a 1 to 4 day hospital stay and a 3 to 5 months recovery program.
This is the better choice over all as putting it off will only create the inevitable anyways.
I can use some peptides and sarms to help in recovery as well as adapt to new things to ensure it doesn't happen again ot atleast preventative measures.

My thought to you is just get it over with, the hell with stints, over n over again.

 

[deeoeraclea]

Your thought process on all this seems very sound. Please share how things progress. Wish you the best and a long and healthy life.

I ended up going with the stents. I didn't see any compelling reason to submit myself to a major operation -- including all of the risks -- when there was a simpler option that wouldn't burn any bridges. I felt much better right after the stent was put in. Now I just need to do everything I can to keep my LDL as low as possible.

 

[bigMoJo]

I ended up going with the stents.

It's good to know you're well and it's behind you, especially now during the holidays.

Now I just need to do everything I can to keep my LDL as low as possible.

There is a ton of information on this board about controlling LDL. @egruberman is very knowledgeable about the intricacies, you may want to search his posts.

 

[egruberman]

It's good to know you're well and it's behind you, especially now during the holidays.

There is a ton of information on this board about controlling LDL. @egruberman is very knowledgeable about the intricacies, you may want to search his posts.

Happy to offer any guidance I can, though:

Presently, I am on Rapatha (a pcsk-0 inhibitor) and Zetia.

Sounds like you're already on some lipid lowering meds. I've two questions, the first of which is have you tried a statin? Repatha plus Zetia is typically used for statin-intolerant patients. A low dose statin will definitely move the needle on top of what the PCSK9i and ezetimibe.

Second question is whether you've considered bempedoic acid. In the US, it's marketed as either Nexletol (180mg bempedoic acid) or combined with ezetimibe 10mg, which is marketed as Nexlizet. They're offered in combined form because they're very complementary.

FWIW, I'm running all four compounds. Rosuvastatin 10mg and Nexlizet daily plus Repatha bi-weekly injections. I hate using LDL over ApoB, but this is what mine looks like on that stack:



ApoB is 32mg/dL.

My LDL was never quite that high my total was north of 200 a bit if diet and exercise was off and LDL was 120ish mg/dL. My CT-CAC was ~44, should've been zero. My aim is to smash ApoB (and LDL) and see if I can't managed to reverse some plaque. There's no consensus that suggests that's possible, but a little data that's promising.

 

[OldGHGuy]

I think your doctor's advice may be coming from the idea that stents can block back up after a long time horizon (like you probably have at 42). I can share, however, that 20 years ago my dad had a heart attack when he was 58 and had 3 stents put in for 3 different blockages of varying degrees, the worst being 95%. He's now 78 and still doing great on those 3 stents...for what it's worth.

I wouldn't dare give medical advice in this situation but I would recommend getting a 2nd opinion at the least.

 

[Excel.exe]

Rosuvastatin 10mg and Nexlizet daily plus Repatha bi-weekly injections.

statins like rosuvastatin increase pcsk9 levels to 30-50%.
repatha works by inhibiting pcsk9.

why use those 2 together?

 

[deeoeraclea]

Happy to offer any guidance I can, though:



Sounds like you're already on some lipid lowering meds. I've two questions, the first of which is have you tried a statin? Repatha plus Zetia is typically used for statin-intolerant patients. A low dose statin will definitely move the needle on top of what the PCSK9i and ezetimibe.

Second question is whether you've considered bempedoic acid. In the US, it's marketed as either Nexletol (180mg bempedoic acid) or combined with ezetimibe 10mg, which is marketed as Nexlizet. They're offered in combined form because they're very complementary.

FWIW, I'm running all four compounds. Rosuvastatin 10mg and Nexlizet daily plus Repatha bi-weekly injections. I hate using LDL over ApoB, but this is what mine looks like on that stack:

View attachment 308818

ApoB is 32mg/dL.

My LDL was never quite that high my total was north of 200 a bit if diet and exercise was off and LDL was 120ish mg/dL. My CT-CAC was ~44, should've been zero. My aim is to smash ApoB (and LDL) and see if I can't managed to reverse some plaque. There's no consensus that suggests that's possible, but a little data that's promising.

Thanks for the detailed information @egruberman .

I did try rosuvastatin before hopping on the PCSK-9 inhibitor. It did lower my LDL and apo-B. But, the muscle soreness was too much for me.

I also asked my doctor about adding bempadoic acid to my medications. She advised against it because (according to her), there is an increased risk of tendon rupture for those on BA. And, given I lift weights, she didn't think it would be worth the risk. Do you have any thoughts on this?

I have yet to see what my LDL and apoB are after upping my dose of repatha from every other week to 3 times every 4 weeks. But, if my LDL is still above, say, 70, I think I will either try the statin again or push for the BA.

For supplements, I'm taking vitamin K as well as nattokinase and fish oil (and other stuff that isn't related to my vacular health). Anything else you would recommend?

 

[egruberman]

She advised against it because (according to her), there is an increased risk of tendon rupture for those on BA. And, given I lift weights, she didn't think it would be worth the risk. Do you have any thoughts on this?

I got the same warning from my doctor. One has to dig into the clinical trials to get the details. Tendon rupture was only a problem when used in concert with high dose Atorvastatin.

I’ve been on it for over a year and my tendon health is as good as it’s been in the last decade as it’s something I’ve taken some focused care on with supplements and such. I’ve seen no ill effects of the BA. Recently I started bouldering again in a gym after laying off for many years. I have technique and muscular strength, but I’m waiting on the tendon strength. I’m pushing my fingers and hands to the limit. If something were going to rupture it’d be now.

For supplements, I'm taking vitamin K as well as nattokinase and fish oil (and other stuff that isn't related to my vacular health). Anything else you would recommend?

Those are good. 10g/day of psyllium husk is effective. It binds bile acid in the intestine triggering the liver tonuse the available LDL to produce more, effectively reducing circulating LDL.

 

[deeoeraclea]

I got the same warning from my doctor. One has to dig into the clinical trials to get the details. Tendon rupture was only a problem when used in concert with high dose Atorvastatin.

I’ve been on it for over a year and my tendon health is as good as it’s been in the last decade as it’s something I’ve taken some focused care on with supplements and such. I’ve seen no ill effects of the BA. Recently I started bouldering again in a gym after laying off for many years. I have technique and muscular strength, but I’m waiting on the tendon strength. I’m pushing my fingers and hands to the limit. If something were going to rupture it’d be now.



Those are good. 10g/day of psyllium husk is effective. It binds bile acid in the intestine triggering the liver tonuse the available LDL to produce more, effectively reducing circulating LDL.

Ah. Hadn't even considered psyllium husk. But, I do recall reading in the past that it lowers LDL. I wonder why doctors never recommend it.

I already eat a lot of fiber from vegetables (steamed broccoli, cauliflower, cabbage, zucchini), winter squash (mostly pumpkin) and oat bran. Is there still an additional benefit of adding the psylliaum husk?

 

[dontletheoldmanin]

Psyllium husk: its a soluble fiber that forms a gel in your digestive system, trapping bile acids and cholesterol. Your liver then removes cholesterol from your bloodstream to produce more bile, which helps with digestion. This process lowers LDL cholesterol levels and may reduce the risk of heart disease.
such as those in psyllium husk, guar gum, flax seed, and oat bran, can help lower cholesterol when added to a low-fat, low-cholesterol diet. Studies have shown psyllium can lower total, as well as LDL (bad) cholesterol levels, which may help reduce the risk of heart disease.

Facts from studies and complied in internet

Psyllium fiber: Regularity and healthier lipid levels? - Harvard Health