80% lesion in mid of LAD

67 year male
all other report are good.

80 % lesion in mid of LAD
also 40% lesion in proximal part

Is it required to go for angioplsty now

[ed34]

This is a very difficult question to answer. There seems to be two major camps now in the world of cardiology. One camp suggests that too much intervention is taking place, and is often unnecessary. They believe that the heart will develop natural bypasses to counteract the lesion. The other camp believes this is true but to an extent. Not everyone has the luxury of having their collateral vessels open, some people end up with dead muscle. Some people even die. So, what do we do? wait and see what happens and hope a patient doesn't die, hope they develop collateral feeds?
Personally I think the best option is to have large lesions treated. My philosophy on the subject is, if you know about a lesion, treat it. If you don't know about the lesion, then is the time for collaterals to hopefully do their stuff. If you have a lesion and collaterals form, then why would opening the lesion cause an issue? yes the collaterals will close, but are we forgetting these are not the 'natural' feed?
I do agree personally that if the RCA is blocked and has formed collaterals, then this should be left because it tends to form loop collaterals, rather than feeds from other major vessels.
This is my analogy...
Imagine 3 taps feeding crops with water. A third of the crops are fed by each tap. One tap blocks, so you insert a T piece into any of the other hoses and feed it from there. Now you have 2 taps feeding all the crops. Now another tap blocks. You put two T pieces into the only feed still working, so now ALL the crops are fed from one source. The crops are surviving very well. Now the third tap blocks, and ALL the crops die. There is nowhere to get a water feed from.
The taps are the 3 major coronary arteries, the T pieces are collaterals, and the crops are your heart muscle. There are more patients than people think relying on a single vessel, feeding through collateral networks to all areas of the heart. When they have a heart attack in that last vessel, it's game over. So, my opinion is to at least keep the two major vessels for the left ventricle as free as possible.