Angioplasty/stents

[thaisabai]

over the past 4 months I experienced some faintings (dizzyness, short breath, sweating, inability to sleep). I believed that there was a connection with a problem I had 5 years ago: diagnosed with right carotid artery 100% blocked.

A hospital in the USA diagnosed Syncope.

I had this checked in the Bangkok Pattaya hospital last week and their suggestion is angioplasty and stenting. (about 400 000B)

I read a lot about this procedure and I must admit I am a little scared. also after reading the risks and complication section on Bumrungrad's website. their website gives me the impression, that this would only be a temporary cure and will most likely have to be repeated frequently in the future.

now (I am in Pattaya) before I want to travel to BKK to see one of your specialists for a second oppinion, I would like to hear from you a little information as follows:

if stenting has to be done, what percentage is the risk that this procedure has to be repeated (provided I change my lifestyle, excersise, loosing weight, stop smoking etc)?

how long would I have to stay in the hospital after the procedure?

will I be able to go back to my job in the US in November (I have an administrative job).

can you give me an approximate cost of the procedure?

my eyes are on 3 hospitals for the procedure. Bangkok Pattaya (where I was diagnosed), Samitivej in BKK (read many good comments) or Bumrungrad in BKK.

any suggestions? any names of top doctors?

any comments appreciated

[Mobi]

I have chronic heart disease, and a few months ago I was booked ionto Bumrungrad for confirmatory angiogram and stent(s). I had already had a number of other tests, all of which indicated the need for angioplasty.

I was booked in early one morning , and was due to be dischaqrged the following day.

In the event they did the angiogram, and decided that my blockage was not serious enough to warrant a stent at this time, and I wa dischaged in the afternoon and even received a refund on my large deposit.

M specialist is Dr Sarurat, who was recommended to me by my diabetic spoecialiust, and I have nothing but praise for this bright young cardiologoist , who is up to speed with all the latest procedures and travels the the USA regularly to keep herself fully informed.

I have absolutely no doubt that if I was admitted to Bangkok Pattaya, I would be the proud owner of at least 2 stents right now.

For matters of the heart I recommend Bumrungrad - they have most of the best surgeons in Thailand.

[benjamat]

I had a mild mci about ten years ago which came from noiwhere, I thought i was fit and heart problems would not get me.

Taken to hospital and given angiogram. During process the surgion told me he could see a blockage and if I wanted ne could put a stent in there and then. It was done and I have had no problems since.

You quote 400,000 baht for this, I guess it is a typo but if not and you are a brit just jump on a p[lane and get it done in UK. Airfare and a little r&r will cost you a lot less than 400k baht

[chiang mai]

If you do a search of this site you will see that this subject has been covered in detail many times, I for one have posted my version of events many times. But one more time:

I had angioplasty at Bumrungrad four months ago and the whole process was painless, stress free and inexpensive. I was diagnosed with a blockage of the RCA that is greater than 85% and stenting was recommended. Check into Bumrungrad at around 10.0am on a Saturday and spend a few hours in ICU whilst being monitored and watching TV - roll into the cath lab at 1:0 and all done by 2:0. The process involves an injection of pain numbing medication in the groin then watching on the fluroscope as the doctor does his job - no pain at all. Afterward it's a case of laying in bed with your leg straight for six hours so as to allow the wound in your groin to heal and by 8.0 am the next day you are up and about - get released around noon.

Cost of the process for me was 140,000 and that included a bare metal stent - I allowed the surgeon to make the decision on the type of stent because he knows far more about the pro's and con's than I will ever do. Subsequently I find there is a much debate about the sense of using drug eluting stents and the juries seem to be coming out to suggest they do not offer any more protection over bare metal stents if the patient is also on Plavix and Aspect. Costs of using drug eluting stents will be significantly higher.

I recommend Dr Arram at Bumrungrad - trained in the US and very very professional and recommended highly by the OR nurses.

Will you need to be re stented you ask. I have read all manner of reports on this subject and have learned much since I first embarked on this angioplasty journey. Latest expert medical opinion suggests that stenting is only valuable in the first place is the patient has symptoms, if they do not then medication alone will prove equally as effective. There is absolutely no difference between survival rates of people who have had stents inserted and those who have been put on medication alone. A recent finding is that those people with stents benefit for about three years and thereafter the arteries suffer from restenosis to the point that there is no benefit to be gained from having the stent.

Finally, diet, exercise and not smoking can benefit everyone in that it delays or reduces the degree to which restenosis occurs.

[chiang mai]

I had a mild mci about ten years ago which came from noiwhere, I thought i was fit and heart problems would not get me.

Taken to hospital and given angiogram. During process the surgion told me he could see a blockage and if I wanted ne could put a stent in there and then. It was done and I have had no problems since.

You quote 400,000 baht for this, I guess it is a typo but if not and you are a brit just jump on a p[lane and get it done in UK. Airfare and a little r&r will cost you a lot less than 400k baht

Getting it done privately in the UK will cost in the region of £14,000 at Bupa/Spire hospitals but you get chose whether you want C-Diff or any of the other diseases available currently - since the poster is American he will be unable to get it done on the NHS.

[zzdocxx]

Just to clarify -- what is under discussion is stenting of one or more coronary arteries, the issue being the symptoms you described. (Not stenting of one of your carotid arteries.) Is this correct?

When you say you had it checked at BP Hospital, what exactly do you mean? Did they do some tests? If so, what were they and what were the results?

[chiang mai]

Opps, well spotted, apologies. I have heard that the carotid artery is also the subject of angioplasty but had not spotted the difference in the OP. Hopefully the details in my post will serve some useful purpose to the OP.

[zzdocxx]

(It wasn't clear to me either.)

Edited October 5, 2008 by zzdocxx

[manjara]

Not that I want to be alarmist, but my father went into an NHS hospital in the UK for an angioplasty. The procedure went wrong and they ruptured the artery. He was rushed into emergency heart surgery and got a triple bypass, nearly died, then after some time in intensive care they moved him to a normal ward. During the Op and in post-op care they didn't look after the circulation enough and he got gangrene in his feet, causing them to have to amputate part of both feet. His circulation has never recovered and his legs below the knees are a mess.

The doctors and the care in the UK was pretty awful, and they were more concerned with avoiding any possible admission of error than correcting the numerous problems/complications that occurred. I found myself having medical arguments with the doctors, even though I have no training in that area.

Contrast with that, my experience of Bumrungrad, where my mother-in-law had a total knee arthroplasty. Surgery was arranged in a matter of hours, everyone was very knowledgeable, informed us of what was happening and within a week she was up and walking with virtually no scar.

The UK treatment was free, but you get what you pay for...

[G54]

^^^^ Free it may be and in many cases dam_ good.

Not all procedures will go as planeed whether you pay for them or not. I had 2 stents fitted with no problem at all and cannot praise the NHS staff highly enough. If it was not for the NHS doctor who gave me an angiogram and then sent me to the hospital even though the reading was OK, I doubt I would be alive today. So please do not lump all surgeons of the NHS into one category.

[chiang mai]

Not that I want to be alarmist, but my father went into an NHS hospital in the UK for an angioplasty. The procedure went wrong and they ruptured the artery. He was rushed into emergency heart surgery and got a triple bypass, nearly died, then after some time in intensive care they moved him to a normal ward. During the Op and in post-op care they didn't look after the circulation enough and he got gangrene in his feet, causing them to have to amputate part of both feet. His circulation has never recovered and his legs below the knees are a mess.

The doctors and the care in the UK was pretty awful, and they were more concerned with avoiding any possible admission of error than correcting the numerous problems/complications that occurred. I found myself having medical arguments with the doctors, even though I have no training in that area.

Contrast with that, my experience of Bumrungrad, where my mother-in-law had a total knee arthroplasty. Surgery was arranged in a matter of hours, everyone was very knowledgeable, informed us of what was happening and within a week she was up and walking with virtually no scar.

The UK treatment was free, but you get what you pay for...

Well if the OP wasn't a little scared at the prospect of having this work done before, he certainly will be now!

Note to the OP: as I recall the risk associated with the procedure is about 4% but the vast majority of it is associated with (a) use of the dye that is used to highlight blood vessels, and ( the risk of haematoma (sp) resulting from the wound at the entry site in the groin. Both of those risks can be mitigated by specific actions on the part of the surgeon. The risk associated with ruptured blood vessels varies from surgeon to surgeon according to their skill. One of the beauties of Bumrungrad is that the Cardiac surgeons there do two or more agioplasty's daily, every day of the week, so for them it is all very routine.

Edited October 6, 2008 by chiang mai

[thaisabai]

Just to clarify -- what is under discussion is stenting of one or more coronary arteries, the issue being the symptoms you described. (Not stenting of one of your carotid arteries.) Is this correct?

When you say you had it checked at BP Hospital, what exactly do you mean? Did they do some tests? If so, what were they and what were the results?

thanks for the answer. it is overwhelming how many answers I received.

yes, we are talking of stenting coronary arteries (2 mildly narrowed and one severely). the carotid artery thing is another matter, have a 100 % blocked carotid artery since 5 years and have to take Plavix)

the BPH did a CT scan (64 slices) and a stress test. I am not questioning their findings, it is just that I have read many articles that say some doctors are too quick to decide on stenting.

thanks again

[Mobi]

Just to clarify -- what is under discussion is stenting of one or more coronary arteries, the issue being the symptoms you described. (Not stenting of one of your carotid arteries.) Is this correct?

When you say you had it checked at BP Hospital, what exactly do you mean? Did they do some tests? If so, what were they and what were the results?

thanks for the answer. it is overwhelming how many answers I received.

yes, we are talking of stenting coronary arteries (2 mildly narrowed and one severely). the carotid artery thing is another matter, have a 100 % blocked carotid artery since 5 years and have to take Plavix)

the BPH did a CT scan (64 slices) and a stress test. I am not questioning their findings, it is just that I have read many articles that say some doctors are too quick to decide on stenting.

thanks again

I had a stress test in conjunction with some kind of ultra sound. (much cheaper than a cat scan). I have this annually. The doc said it looked like I need at least one stent, and asked if I wanted to verify it with a cat scan or go for the angiogram (which she said is more definitive). I was booked in for angiogram and angioplasty but as I said earlier, in the event she decided the stents weren't called for at this stage. Just continue the meds and lifestyle.

That is why I thoroughly recommend you go to Bumrungrad and NOT Bangkok Pattaya.

Just my opinion, of course.

[zzdocxx]

From what I understand, putting in stents depends on having symptoms which will be relieved.

Are you still having those symptoms, or are you being treated with different medications now and are your symptoms are gone?

I agree with above that a second opinion is worthwhile, maybe Mobi or someone can give you the name of a good cardiologist.

Good luck, please keep us posted with your progress.

[thaisabai]

From what I understand, putting in stents depends on having symptoms which will be relieved.

Are you still having those symptoms, or are you being treated with different medications now and are your symptoms are gone?

I agree with above that a second opinion is worthwhile, maybe Mobi or someone can give you the name of a good cardiologist.

Good luck, please keep us posted with your progress.

thanks guys for all your ecouraging answers.

I have an appointment now in Simitivej in Bangkok and from there will proceed for another appointment to Bumrungrad.

although I heard a lot of good things about Simitivaj, I see from your guy's comments that Bumrungrad seems to be the best. will keep you posted

thanks again

[BAYBOY]

I had my first heart attack whilst on holiday in Phuket in August 1988., aged 43. Two days in hospital there , then the Travel Insurance Company flew me to Sinapore for 3 weeks hospital and rest, then flew me back home to New Zealand. Four months later had an angioplasty operation in N.Z. No problems with that... recovered and continued to live a normal life.

Came to live in Thailand in 1997 and in 2001 had my second heart attack.The very first sign of any trouble since 1988.Went to Phyathai 2 Hospital in Bangkok, who looked into another angioplasty, but the problems too severe so had a quadruple by-pass.

The Doctors there amazed that I had gone from 1988 to 2001 without any problems following the angioplasty in Dec. 1988.

Since then I have (touch wood) had no problems. Work teaching here 5 days a week and look after 10 rai of garden including mowing 5 rai by push mower, which takes 9/10 hours over 2 days. Try to live a stress free life as firm believer that is a majoRr factor in heart attacks. Living in rural Thailand is stress free!!!! or nearly.

Always have been very happy with the care, attention and service from Phyathai 2 ........their Heart Center is wonderful. Associatted with the Harvard Medical Center in the U.S.A.

Make sure you feel totally at ease with your Medical/ Hospital/ Doctor that you choose.

BAYBOY

[benjamat]

I had a mild mci about ten years ago which came from noiwhere, I thought i was fit and heart problems would not get me.

Taken to hospital and given angiogram. During process the surgion told me he could see a blockage and if I wanted ne could put a stent in there and then. It was done and I have had no problems since.

You quote 400,000 baht for this, I guess it is a typo but if not and you are a brit just jump on a p[lane and get it done in UK. Airfare and a little r&r will cost you a lot less than 400k baht

Getting it done privately in the UK will cost in the region of £14,000 at Bupa/Spire hospitals but you get chose whether you want C-Diff or any of the other diseases available currently - since the poster is American he will be unable to get it done on the NHS.

Sorry, I hadnt noticed the poster was from the states.

On a personal level I would not pat for private treatment in the uk but would certainly do plenty of research on hospitals and doctors, especially for infections. I have paid NI all my life so dont see the nhs as a free service.

[sangfroid]

http://www.bangkokhospital.com/eng/heart_surgery.aspx

Dr Kit Arom comes highly recommended.

Dr.Kit Arom, MD,PhD in Surgery, a world renown cardiac surgeon who spent over 30 years at the Minneapolis Heart Institute in Minnesota USA, leads the cardiac surgeon team of the Bangkok Heart Institute.

[benjamat]

The UK goverment has announced today that angioplasty and stenting is to be given as main treatment instead of drug therapy. Now if you have severe angina or MI you will be taken to hospital for immedaite angio, even as emergency and 24/7.

[Lost in LOS]

I do have the following symptoms that the OP has..........dizziness, short breath, sweating, inability to sleep

I get a somewhat dizzy when standing after sitting or a while but it is better after five minutes of walking

I have a little shortness of breath but wonder if that has to do with allergies as i am really stuffed up all the time

I sweat a lot while sleeping even with the A/C on

I cannot sleep very well but I do have sleep apnea, cant use the cpap machine very well because of clogged nose and decongestants just don't work

I consider myself to be in good shape, blood pressure good, pulse good, not overweight, but i am tired most of the day without a lot of energy but push myself and I am active. I walk my dog 4 kilometers a day, do 50 push ups a day and work out with weights a couple of times a week. I drink, at the most, one Bacardi breezer a day, I like the lemonade.

i want to be safe than sorry and want to get tests done. what are my best options. i live in pattaya so Bangkok pattaya hospital is most convenient and they just opened a heart center. if i need any elaborate procedures done i will go to Bumrungrad in bangkok. from reading this i think i need the following:

stress test [had last one 6 years ago with good results]

ultra sound [had last one 6 years ago with good results]

64 slice MRI? never had one and i am really claustrophobic so unless they drug me i would rather die than get in that machine : (

what are your suggestions as to the proper test so when i go this week for a checkup i make sure i do the right things

thanks Jimmy

Edited October 20, 2008 by jimmys

[Mobi]

Jimmy, I really recommend that you go to Bumrungrad.

You can either take the bus to Ekami and then jump on the Sky train, or drive there in just over the hour. You can easily do the visit in one day, without the need to overnight.

Bumrungrad has the pick of all the top heart specialists in Thailand, and I have been going there for years.

Earlier this year I had my stress test, combined with an ultra sound - this indicated a worsening of my condition and the following week I had an angiogram, as the doc said it was more reliable than the scan. I have had 4 angiograms through the years with no ill effects.

In the event my arteries are not yet considered bad enough to warrant stents.

I know Baangkok Pattaya is convenient, and they have all the latest equipment and some good doctors , and I have used them in the past; but now, personally I just don't trust them. They have this "generate as much money as you can" culture which conflicts with proper medical practice.

I suggest you also discuss your breathing problems/allergies with your Doc, as that is also important to getting a decent night's sleep. Did you know that many 'night time' breathing allergies are caused by mites in you bed clothes? You might want to check into this.

[tampasailor]

A recent finding is that those people with stents benefit for about three years and thereafter the arteries suffer from restenosis to the point that there is no benefit to be gained from having the stent.

Yes this has been my experience, 2 stents, 3 years ago in 14 year old vein grafts totally occluded now. Another stent now in another position to help while we think of what to do next. I will be in BKK Oct and Nov and also travel to Chaing Mai a lot. Any advice appreciated. Now in Florida for Proton Therapy for Prostate Cancer and I can certainly advise on this subject if I can help you.

[sleepyjohn]

Not that I want to be alarmist, but my father went into an NHS hospital in the UK for an angioplasty. The procedure went wrong and they ruptured the artery. He was rushed into emergency heart surgery and got a triple bypass, nearly died, then after some time in intensive care they moved him to a normal ward. During the Op and in post-op care they didn't look after the circulation enough and he got gangrene in his feet, causing them to have to amputate part of both feet. His circulation has never recovered and his legs below the knees are a mess.

The doctors and the care in the UK was pretty awful, and they were more concerned with avoiding any possible admission of error than correcting the numerous problems/complications that occurred. I found myself having medical arguments with the doctors, even though I have no training in that area.

Contrast with that, my experience of Bumrungrad, where my mother-in-law had a total knee arthroplasty. Surgery was arranged in a matter of hours, everyone was very knowledgeable, informed us of what was happening and within a week she was up and walking with virtually no scar.

The UK treatment was free, but you get what you pay for...

Manjara

Sorry to hear about your father, but............you said you didn't want to be alarmist, but actually that's exactly what you were.

Anecdotes are worse than useless when based on uneducated opinion such as yours.

There is a small risk attached to any procedure like this. Whilst saying explicitly that you had no medical training you gave views on medical procedures and occurrences. What's more you damned the NHS at the same time.

I could give you anecdote after anecdote in favour of the NHS, but I won't bother for the same reasons you shouldn't have bothered.

[sleepyjohn]

.

Edited September 19, 2009 by sleepyjohn

[Dario]

We just checked my mother out of Bumrungrad Hospital after 3 days here and 2 days at the ICU at Pattaya Memorial. She would need angioplasty but seen her age of 87, doctor Aram Chusid doesn't want to take the risk, the more she has problems with the major bloodvessel leading to her kidneys.

Just for your info: a 69-year old Swiss chap was flown by private jet (organized by REGA in Switzerland) from Phuket to Bangkok earlier this week after a heart attack. He had 2 stents inserted here at Bumrungrad 2 days ago and he told me that he paid CHF 20,000.00 which is 650,000 Baht. So, please forget about 150,000 Baht for the package at Bumrungrad mentioned earlier in this thread ...

There is an alternative to angioplasty which is noninvasive and has fewer risks called EECP - enhanced external counter pulsation. It is available in Thailand. Check that out.

Edited November 21, 2009 by Dario

[chiang mai]

We just checked my mother out of Bumrungrad Hospital after 3 days here and 2 days at the ICU at Pattaya Memorial. She would need angioplasty but seen her age of 87, doctor Aram Chusid doesn't want to take the risk, the more she has problems with the major bloodvessel leading to her kidneys.

Just for your info: a 69-year old Swiss chap was flown by private jet (organized by REGA in Switzerland) from Phuket to Bangkok earlier this week after a heart attack. He had 2 stents inserted here at Bumrungrad 2 days ago and he told me that he paid CHF 20,000.00 which is 650,000 Baht. So, please forget about 150,000 Baht for the package at Bumrungrad mentioned earlier in this thread ...

There is an alternative to angioplasty which is noninvasive and has fewer risks called EECP - enhanced external counter pulsation. It is available in Thailand. Check that out.

The type of stent used in angioplasty determines the majority of the cost of the process and where medicated stents are used the cost is likely to be quite high. But if you look into the benefits of using medicated versus bare metal stents you'll see that the medical community is fast coming down in favour of using the cheaper bare metal stents. This is because medicated stents lose their efficacy after about three months and because regardless of which type is used, patients are typically prescribed oral Plavix or similar for at least one year following the procedure. Oral Plavix achieves a similar result to using medicated stents hence there is little benefit to be gained from using the more expensive stent.

Perhaps an even more interesting extension of that debate is a recent study by the Mayo Clinic that compared survival rates between patients taking Plavix alone versus those having angioplasty - the finding after twelve months were virtually identical in both cases thus the case for having angioplasty seems suspect, unless bleeding causes other problems. http://www.mayoclinic.org/

Edited November 21, 2009 by chiang mai

[Phil Conners]

Perhaps an even more interesting extension of that debate is a recent study by the Mayo Clinic that compared survival rates between patients taking Plavix alone versus those having angioplasty - the finding after twelve months were virtually identical in both cases thus the case for having angioplasty seems suspect, unless bleeding causes other problems. http://www.mayoclinic.org/

The provided link just leads to the main Mayo Clinic website. I searched both on the websites and through Google and have been unable to find any more information about this study.

[WarpSpeed]

There is an alternative to angioplasty which is noninvasive and has fewer risks called EECP - enhanced external counter pulsation. It is available in Thailand. Check that out.

This treatment is not recommended as an alternative to the procedures discussed, it is recommended as a final treatment for those not realizing angina relief from conventional treatments and have no options to consider to gain relief from chronic angina...