Can angioplasty help clear the clogged arteries?

Question

Hello doctor,

My mother is 59 years old and recently had an ischemic attack (troponin T test positive, CPK-MB elevated). She underwent a BMV for mitral stenosis two years ago. She is currently in the ICU, receiving medical therapy (antithrombotics). She underwent an angiogram yesterday (report and video attached). Her RCA is 100 percent chronically occluded, and her LDA and LCX have 70 and 90 percent occlusions, respectively. I have the following questions:

What is the likelihood that angioplasty will help with the total occlusion in her LCX? Will newer technologies, such as Rotablator or IVUS, increase the chances of clearing the totally occluded artery?
We are at a center without surgical facilities, so bypass surgery would require transferring her to another hospital. How safe is it to perform angioplasty in this situation?
Would you consider it risky to transfer her to a larger city, which would involve three hours of road travel, followed by a two-hour flight, before waiting for surgery?

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

I am sorry to hear about your mother's poor health. There is a very good chance that angioplasty, along with stenting, can help with the 100 percent blockage. She is still young, and if she can adhere to lifestyle modifications and medications, it will be beneficial. A rotablator or IVUS (intravascular ultrasound) can definitely assist in clearing the clogged arteries. However, they will still require stenting, as the affected areas of the arteries have become weakened and will need the support of a stent. In situations like this, I typically recommend angioplasty for my patients. The recovery period is shorter, and patients can live a quality life with lifestyle modifications and medications. It is not safe for her to undergo the stress of traveling at this time.

I hope this helps you.

Thank you.