LCX 50 % OSTEAL STENOSIS-what to do?

[ash369]

50 yr old male patient.angiogram shows 40-50% osteal stenosis of LCX.any need for stent? pls advise

[Stentman43]

Just wanted to let you know, don't always trust a stresstest, they are only 80% accurate.  Two of mine said I was totally good and ended up having open heart surgery after a cath.  Thank God my Cardiologist listened to me instead of trusting the test!!

[ash369]

thanx friends.i am much relaxad now

[Flycaster305]

'Osteal' refers to a blockage at the junction of a branch artery.  It is a difficult area for a stent to be placed.  A 50% blockage is still allowing for a lot of blood flow.  That said, it needs to be watched carefully, as a dirty pipe allows junk to build up, sometimes in a New York Minute.  
I'd certainly request a nuclear stress test yearly, and I'm sure you are taking aspirin and Plavix or Coumadin.  If you haven't adopted a strict Cardiac diet, I'd do so.  Also exercise is essential.  If you are diabetic, I'd test often and report the results.  
Like the above posters, I've had a lot of stents.  My last stent included two in the Ostial position, one 85% and the other 65%.  Insurance covered both.  In one of the arteries it was straightened out to prevent the turbulence that Ed34 refers to.  I have congestive heart failure so insurance rules depend on the situation and level of discomfort and also condition of the patient.  

[ed34]

In Europe there is also a guideline of 70%, but to us that's all this is. If a patient has a lot of symptoms and medication isn't helping, then stenting is almost always the procedure performed, regardless of blockage percentage. You basically can't have a patient in constant pain and do nothing. I had a recurrence of bad angina a while back and the angiogram revealed nothing. Not even a 1% blockage was shown. Using FFR down the LCX, the drop off of flow half way down was huge. They had to insert 2 stents to stop the turbulence. So in effect, I had 2 stents with 0% blockages. Is it not the same rule for insurance companies there? if not then they should review it.

[Stentman43]

I can help you with this question.  The answer is no, they will not stent.  Insurance dictates it has to be greater than or equal to 70%.  Believe me, I know, I have 50 stents (yes, you read it right) and it has always been >70%.  And if it's near a bifurcation, that can be repaired too b/c my Cardiologist invented what's called a kissing stent.  One stent comes in from each direction and touch, thus the kissing stent.

[ed34]

not much information to go on here. What about symptoms? did they perform FFR during procedure? is it right next to bifurcation or on it?