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Questions for Dr. Kennedy
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Vascular Surgery
Posted by: Olaya
Date: March 8, 2001 9:40 PM

I have yet to see or hear anyone explain adequately why plaque on the coronary artery walls or anywhere cannot be simply cut away from the wall. I guess my question is what is the consistency of the plaque that will not allow it to be shaved away for instance. It is apparently soft enough to be pressed against the wall by a balloon but not soft enough to be suctioned off the wall, yet it is unstable enough to break away from the wall on its own. Could sensors on a knife recognize healthy vascular walls over calcium or fatty plaque deposits? I understand after reading your articles that the initial plaque deposit may be in response to cracks in the vessel wall. Then would removing that plaque cause a bleed in the wall? Is there no instrument specific to what I am describing here? Do the plaque deposits break away from the vessel wall if the wall repairs itself? Can the wall repair itself while plaque is attached? Please if you could direct me to any data, study or articles on attempts to surgically remove vascular plaque it would be appreciated.

RE: Vascular Surgery
Posted by: Ron Kennedy, M.D.
Date: March 9, 2001 12:17 AM

The plaque is itself the repair. Healthy collagen repair had no chance, thanks to vit. C (ascorbate) deficiency and the lipid/scar/debris which formed is the next best thing. It is partially scar tissue, partially dead cells, lipids, etc. To remove it is tantamount to removing the artery wall itself. If you cut into a plaque trying to shave it away, you would do more damage to the vascular wall provoking more plaque formation. The critical consideration is the patency of the lumen. I disagree with bypass grafts and stints except in the very late stages of the disease and only as a critical life-saving measure. These criteria are rarely satisfied as surgeons stampede people into surgery who have a little chest pain and some degree of plaque. Nevertheless, the fundamental mechanical idea is sound, namely increase the lumen. I prefer to do it with intravenous EDTA chelation which removes excess calcium and also promotes the formation of hundreds of collateral channels - nature's own bypass mechanism.

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