Treatment of LAD disease

[Vivek_Garg]

My Father (62. smoker) was having some pain in chest and was also having dullness.
Then we were suggested for CT Coronary Angiography.

The result of it is -

CALCIUM SCORE : 10.98
AORTA : is normal
LEFT CORONARY ARTERY : Origin of left is normal in position

LAD : is severely diseased with long segment mixed plaque in proximal part causing severe stenosis. Lenth of stenotic segment is approx 4 cm. Distal circulation is good and septal branches are normal. No calcification seen

LEFT CIRCUMFLEX : is normal with ggod circulation. There is tiny calcification in mid part with no evidence of significant stenosis. Obtuse marginal branches are normal.

RIGHT CORONARY ARTERY : is non dominant and normal in origin  with normal ostea. Distal RCA and its branches are normal.

DOMINANT CIRCULATION : Left sided

HEART CHAMBERS ANATOMY : are normal , LVEF- 80%

LIMA AND RIMA : Normal

PULMONARY CIRCULATION : is normal

As consulated for the above report with 3 doctors, one has suggested for PTCA and another two has just written medicines .

My question is

Is PTCA necessary or can be treated with medicine also or is there any other treatment available in India.

Kindly reply at the earliest.

[kenkeith]

From what I read It is pretty well settled in the medical community that the best therapy is symptom relief treatment as no medication or intervention is a cure.  Seldom does an occlusion (hard plaque) within the lumen cause a heart attack.  

If the downstream side of a blockage is adequately supplied blood, a mechanical opening (stent) can be disruptive to the blood supply that has been established by a natural bypass.  Because blood will flow through vessels that have the least resistance, opening the occluded vessel will reduce the resistance and blood flow will probably cease through the collaterals and the new blood flow may not be as adequate when compared to the natural bypass.

Medical report indicates there is a good supply of blood downstream from the occlusion no intervention is needed if there are no symptoms..  Also, stents can be problematic by causing a heart attack clot, restenosis with overgrowth (inflammation) of tissue, etc.  
  

[ed34]

Wow nicely spotted, I missed that in the small print.

[kenkeith]

I agree with  joanincarolina 100% with the comment to quit smoking!  Almost daily there new statistics that unfavorably relate smoking to cardiovascular system as well as impairment to good oxygenated blood (vital to heart cells) with nicotine in the lungs.  In fact the chest pain could be directly related to smoking and possible shortness of breath.  There is treatment to help individuals stop.

[joanincarolina]

Your dad needs to quit smoking! For best long term quality of life he needs to quit, and not even be around second hand smoke.Do a google search and learn the direct relationship that smoking has on the cardiovascular system.This is one area that he can make a decision about that can really impacts the health of his heart.Best wishes.

[ed34]

I think the difference in cardiologists extends to the general public too. There seems to be two camps. One prefers large blockages to be intervened while others would prefer using medication. At the end of the day, you have to look at the pros/cons for each and make your own decision based on what you feel more comfortable with and what you think will give the best long term prospects.

[kenkeith]

QUOTE: "Lenth of stenotic segment is approx 4 cm. Distal circulation is good and septal branches are normal. No calcification seen."

I have a 100% blocked LAD and been on medication for 6 years with no progression or heart problems. There are collateral vessels that provide a natural bypass.

I isolated from your post one comment that should be focused on.  There is some serious occlusion with the LAD, but the comment states there is good distal circulation that indicates there are other vessels that are feeding blood to the area that an open LAD would oxygenate.

Calcium score is good as are all other information...I had a calcium total score over 1000! Medication should be the therapy with some attention in the future of any advancing medical problems.

[ed34]

Different cardiologists seem to have different views and I think some are more aggressive with intervention than others. The report says the top of the LAD has severe stenosis, but it doesn't state what percentage the blockage is.
From my own experience, I would accept the stenting if an option because if this blockage becomes worse, then bypass might become the only option. Your Father is still young (62) so he should have many years left. The left artery is a very dangerous one to form a total blockage, hence the name (widow maker).