The Next Two Stents

As I mentioned in a previous blog (http://rgrivera.blogspot.com/2023/01/the-arterial-coronary-stent.html), I had a procedure yesterday to unblock a couple of my heart arteries that were measured as 99 % blocked two weeks prior.  The procedure I had yesterday turn out to be a little more complicated that was planned and it ended up taking about twice as long, almost four hours to perform.  Luckily I got to see the actual procedure, that is, the arteries around my heart, in real time on a large TV screen.  The procedure was successful and I lived to see another day, and with luck and some effort, I may get to see many more days.

 

The original objective was to get inside the two arteries, open them up with the balloon and insert a stent to keep it open.  It sounded simple enough, a guide wire is moved into and across the blockage. A balloon catheter is pushed over the guide wire and into the blockage. The balloon on the end is blown up (inflated). This opens the blocked vessel to allow a wire meshed tube (stent) to be inserted that keeps the artery open and restores proper blood flow to the heart.  But nooooooo!  Nothing on me could be that simple or follow normal procedure.

 

The probe that was inserted through my groin and into the arteries around my heart showed that the blockage was made up of vascular calcification.  Vascular calcifications are mineral deposits on the walls of your arteries and veins. These mineral deposits sometimes stick to fatty deposits, or plaques, that are already built up on the walls of a blood vessel.  Vascular calcifications are common but potentially serious.   

 

When the blockage is "soft" it can be expanded with the balloon and the arterial wall will expand without tearing so as to allow the stent to be placed.  But when it is calcified the blockage is hard and it cannot expand, and if it does it might beak and damage or tear the arterial wall.  In cases such as these, the calcium is either cracked or scrapped and removed before a stent is inserted, or you have to have bi-pass surgery to bi-pass the blocked portion of the artery.  these are normally not done due to the possibility of tearing the artery.

 

Lucky for me, the U.S. Food and Drug Administration (FDA) cleared Shockwave Medical's Intravascular Lithotripsy (IVL) system  about two years ago to treat severely calcified coronary artery disease.   Intravascular Lithotripsy uses sonic pressure waves, also known as shockwaves, that pass through soft arterial tissue and preferentially disrupt calcified plaque by creating a series of micro-fractures. After the calcium has been cracked, the artery can be expanded at low pressure and a stent safely implanted to improve blood flow with minimal trauma to normal arterial tissue.  Cool hah?  is sort of the similar process used to safely break up kidney stones.

 

Again, the team of doctors and nurses I had working on me were professional and efficient.  Although the process went very smooth, there were some tense moments when the IVL was being used and the subsequent expansion of the fractured calcium obstruction was expanded to insert the stent.  Again, because of the radioactive dye that was injected, the whole section of the heart and the arteries being worked on was displayed on several large scaled monitors that I could watch.

 

It is an interesting perspective when one is watching our mortality evolve in front on a large TV monitor.  It is interesting to realize that, if not for a stroke of luck I could have been dead.   The calcium could have broken off and blocked the flow of blood and most likely one would die, or the arterial wall could have been torn and again one would die, or at any time during the process the arterial wall could have torn and again one would die.  I did not know how close to death I was until I saw what was going on and realized the implications.  In fact, except for a quirk of fate, I could have died at anytime in the past several years, when unknown to me, when this condition more severe.

 

Of course, I am not out of danger yet.  This "fix" may buy me a few years, If I'm lucky.  Coronary artery calcification is age and gender-dependent. it affects 90% of men and 67% of women older than 70 years of age.  It is possible that I could have calcifications in other parts of the body.  I need to have a series of test to see if I do have this condition.  I get all types of advice on what to do to improve my condition from diet to exercise and stress reduction. 

 

Diet might have an impact, but cholesterol has a bad reputation, since excess cholesterol in the bloodstream is a key contributor to artery-clogging plaque.  However, the role of cholesterol in your body is not all negative.  cholesterol a crucial building block in cell membranes, it also is needed to make vitamin D, hormones (including testosterone and estrogen), and fat-dissolving bile acids. In fact, cholesterol production is so important that your liver and intestines make about 80% of the cholesterol you need to stay healthy. Only about 20% comes from the foods you eat.  Unfortunately, I was told about 35 years ago that my body produces excess cholesterol.  

 

I am also told that exercise is good for me, and I think it is, but I have also read that exercise increases parathyroid hormone levels which could facilitate coronary calcification. Exercise could also increase atherosclerosis by increasing shear stress in the coronary arteries.   That was a surprise, I always thought it was just the opposite.  A more serious factor for coronary calcification could be stress.   Research indicates that chronic psychological stress can increase the risk of atherosclerotic diseases, including strokes and heart attacks. Chronic stress is pervasive during negative life events and can lead to the formation of plaque in the arteries.

 

I tend to believe that the primary factor, at least in my case, is genetics with diet being the secondary factor.  My father's side of the family, including my father, have lived to their 90s and never displayed any signs of heart decease.   In contrast, my mother's side of the family, including my mother, had heart decease and many died of heart-related problems.  There is some genetic factor that seems to be transferred to the offspring that makes us susceptible to heart decease including coronary calcification.   But regardless of the reason, it Is best to follow a healthy diet, healthy and moderate exercise and a stress free life to avoid heart problems.

 

Again, the team of doctors and nurses I had working on me were professional and efficient.  Although the process went very smooth, there were some tense moments when the IVL was being used and the subsequent expansion of the fractured calcium obstruction was expanded to insert the stent.  Again, because of the radioactive dye that was injected, the whole section of the heart and the arteries being worked on was displayed on several large scaled monitors that I could watch.

 

I hope not to go through that experience again.