Please suggest me how to interpret Angiogram report

[bmaasire]

Hi,

My father, aged 48 yrs have had chest pain 2 weeks ago. Next day, he went to see the doctor, and was informed to get admitted immediately. After 4 days of medication in the hospital, he is referred to Angiogram. Please find the Angiogram report information stated below. Please check and confirm if he is required to undergo ByPass surgery or medication helps. He is diabetic and BP patient . Please advice..Thanks in advance.

LCMA  : Normal

LAD
  Proximal : Type 3 vessel, 70% Lesion.
  Mid : Two Tandom Tight Lesions.
  Distal : Mild Disease.

Diagonal : Tight Lesion.

RAMUS : -

LCA  
  Proximal : Non Dominent System, Mild Disease.
  Distal : Normal.

Marginal : Large Vessel, Proximal 80% Lesion, Multiple Tight Lesions in Branchs.

RCA: Dominent System, High post origin, Mild Disease Followed by Distal Tight Lesion, PDA PRO

LV-Gram : MILD LV Dysfunction( By 2DECHO)

Post- Cath Diagnosis : # CAD : Three Vessel Disease ( LAD, LCX, RCA)
                                  MILD LV Dysfunction

[joant26]

how do i know the percenrage of blocks in the report

[kenkeith]

My view is it doesn't make sense to intervene with a risky procedure such as a cath puncture, restenosis, etc. if occluded vessels' symptom (angina) can be eliminated with medication.  A patient can always step up from medication to physical intervention with stent or bypass, but there is no stepping back if and when there is a problem with a bypass or stent implant...additionally there is no risk with meds and all 3 procedures (med, stent, bypass) have no bearing on a patient's longivity (COURAGE study).

I have  many years of research on heart physiology, anatomy, functioning of the cardiocvascular system, etc., and I have answered about 10000 posts related to heart issues and probably 4 times that reading of heart related posts for about 8 years.  Recently on this forum a patient had a punctured vessel during a cath procedure and complications thereof and other complications indicating there are many who continue to have problems with heart cardiovascular intervention.  If not necessary for intervention on coronary arteries, I would not have a stent or bypass until if and when there is no other option...there are exceptions.

Ken  

[ed34]

The report you submitted would appear to show a lot of disease in branch vessels, such as margins and diagonals. I can't see how all those can really be bypassed anyway. I would have a meeting with your cardiologist and go through all the available options and remember, his decision may not be the best one. I went through several hospitals in my search for answers and I was shocked how everyone had different opinions. Much of it depends on the experience/confidence of the cardiologist you speak to. From a closer look at your report, and again I am no Doctor, I believe the Left Circumflex is the issue here. The marginal in your Father is a large vessel, but now 80% blocked and some of its branches have tight blockages. The Marginal is a common vessel to form collateral feeds from, across to assist the LAD. Due to this being diseased, it is likely some of those feeds have closed up now, causing Angina to surface.
I would discuss with your Cardiologist about his thoughts of opening the marginal and branches with stenting, to see if collaterals form and assist the LAD which has two tight tandem lesions. Being a large vessel, stenting should present no problem.
The biggest problem with Stents is scarring, not blood clots. You are put on anti coagulation medication to prevent the clotting. Scarring is a response from the body making the repairs, and usually caused by a healthy immune system. The drug on the drug eluting stent is there to prevent scarring, but it has more effect on some people than others. Even if it does scar, it can be cleaned out using a laser. 48 in my opinion is young, and to take medications and be limited with exertion is not necessary and is too soon in life. My marginal has blocked twice in the last 4 years, and always coincides with times of very high stress. The blockages have been in different places, never where stents exist. So my first stent from 4 years ago is still doing great. I was recommended a bypass after my first stent which I didn't want, I wanted them to open my LAD and stent it. I was told it was too risky and bypass would be much better long term. They performed a triple, and it lasted just three months and closed down. THEN they decided the best solution would be to stent it and I had that done in 2010. I feel normal again now, I have 8 stents, but have no limits with exercise and need only blood thinner medication and cholesterol pills. No chest pains, no angina, no shortness of breath, no nothing. It took 4 years to get to this stage, but the journey was very enlightening to say the least. I had an echo scan last week and everything is still looking great.
If you need any advice or opinions from experience etc, we are always here for you.

[nagrajjain]

From my experience I feel with medicines only you can pull on for the time being till further agravation is there. With food, exercise and life style changes you should manage. Need not worry about five years.

[kenkeith]

I had a stent implant in my RCA 7 years ago due to 98% blockage.  My LCX is 72% occluded and the LAD is completely occluded and over a period of many years there has been a bypass with collateral vessels. and appears to be of no medical significance related to a deficit of blood flow to what the LAD would have been supplying .

I have been on medication for the 7 years to avoid any angina pectoris (chest pain due to reduced blood flow with exertion...I take a nitrate just prior to going to the health center for an aerobic workout with no problems 3 times a week.

My treating doctor is a non-interventional cardiologist and treats with medication if the medication relieves symptoms.  There are 3 procedures to treat angina pectoris and that is medication, stent implant and bypass.  I don't see any need for a bypass, but if medication does not relieve symptoms an option may be to stent the 80% lesion with medication...if chest pains (angina) still exist there may be no other option than a bypass....

I'm surprised why there wasn't a stent implant during the angiogram?  Were there any tests prior to the angiogram, and how does your father respond to medication?  You can  google for the COURAGE study regarding the expectations with medication, stent and bypass.  You may want to consult with a non-interventional cardiologist for a second opinion before any bypass or stent implant.  

Hope this provides a perspective and helps you and your husband going forward.  If you have any further questions or comments you are welcome to respond.  Take care,

Ken.

[anandbharti]

Hello,
i am not a Doctor, however, as a cardiac patient myself, this is my advice.  Your father has blockages in three arteries according to the report. My cardiologist told me that if a lesion / blockage is more than 70% then intervention of some kind such as Bypass or angioplasty is required. I am a diabetic too and the first time I had a stent put in by angioplasty, the stent got blocked in three months. At that time, I had double bypass and the bypass are clean after nine years. Nine years ago I saw a report that said that stents get blocked more often in diabetics than non-diabetics.
Stent technology has got better now with Drug Eluting Stents (DES) Unfortunately, they have a tendency to form spontaneous clots that can kill the person. For people with who have DES put in their arteries, Doctors recommend taking strong blood thinners such as aspirin/plavix combination for the rest of their life. I have one DES in my LAD that was placed in the artery last year. In my case the blood thinners have caused long periods of nose bleeding and needed hospital treatment.
OK, given your father's history and my experience, ask your Doctor about bypass surgery. This procedure has longer recovery time but at least the arteries remain clean for a longer time. I believe, the risk of death during angioplasty and bypass is the same at 2% so don't let the fear of getting ones chest opened up frighten you.

Good luck