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Arterial Plaque - two kinds?
Posted by: Jean
Date: July 17, 2002 10:16 AM

My husband had a quintuple bypass this last week - after having a shunt (sp?) put in his heart 3-1/2 years ago. He was in surgery for over seven hours. He is somewhat overweight, is 74 this month, but he is very active - doing often a three mile walk in the mornings.

The doctor who actually performed the surgery was an excellent surgeon, but he frankly told us his one expertise was surgery. He does between 700-800 open heart surgeries a year and could answer none of our questions which did not address that specific area. He also told us the surgery was particulary difficult because the plaque which was causing the blockage was in the form of a toothpaste-like gel rather than a hard plaque. He could not tell us what actually causes this plaque nor why there are two kinds, nor what the differences are, other than one is hard and the other gel-like. He said also that when they clip the arteries with this type of plaque, the plaque will move, and sometime move downward, which could cause further blockage, so they actually had to 'gouge' some of it out of the areries to do the surgery.

Now, I am just an old woman - with sparse education above high-school - but this is the first time I have ever heard of two types of arterial plaque. I have asked every doctor and nurse I've seen at the hospital this last week the following questions, with no satisfactory answers.

1. What causes the two different types of plaque?

2. What exactly is the difference between the two?

3. How can the build-up be prevented?

4. Are there no tests other than the one in which they put the dye into the vein near the groin which will tell us if and/or when additional plaque is beginning to block the arteries before it gets to the stage where it is an emergency and surgery has to be performed?

RE: Arterial Plaque - two kinds?
Posted by: Ron Kennedy, M.D.
Date: July 17, 2002 2:49 PM

At $70,000 per operation and 700 operations per year, I can understand why the surgeon would not answer these easy-to-answer, simple questions of yours. Undoubtedly running back and forth to the bank takes a lot of time.

The really important question, which the surgeon also would not have answered, you did not ask, namely: is there an alternative to surgery? But, I will stick with the questions you asked.

The difference between plaque is the location. Plaque which occurs on the surface of the inside of the vessel is "hard" and easily detectible at angiography. Plaque which develops inside the wall of the vessel is more liquid and much more difficult to detect. It is called "vulnerable" plaque and if it is to cause a problem it does so by rupturing and spilling its fatty material into the vessel and causing blockage downstream from the point of rupture. The Heart Scan Image is a better test to detect vulnerable plaque as it reports the calcium content rather than the image of the inside of the vessel. However, even this test can miss the problem.

Prevention is a long term project involving tests for risk factors, diet, exercise, and nutrients. There is a lot of information on this web site which you can dig out to answer this question. A complete answer would be a small book in size. I suggest you also read:

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