Urgent : Left Carotid Subclavian Bypass v/s Stent in Subclavian

Posted By Alok on June 29, 1998 at 19:09:10:







My father, age 62 has the following situation :
1. Done CABG 10 years back. Having recurrent attacks of giddiness and difference in blood pressure in both the upper limbs since last 6 months. His left radial and brachial pulses are very feeble.
2. His angiography done on June 22nd '98 revealed severe native coronary artery disease with all venous grafts blocked. Severe triple vessel disease. Distal left main has 70-80% stenosis. LAD long segment proximal 50% stenosis. Native vessels are tiny. Proximal Left Subclavian has 90% stenosis with reversal of flow in vertebrals. RCA has 100% ostial block. There is also a 70% block in the abdominal aorta below the renals. LIMA to LAD is patent and seen filling retrograde from native LAD. Echo LVEF 58%. Carotid Doppler shows large left vertebral with retrograde flow. Otherwise normal carotid and vertebral arteries.
3. I understand that a carotid subclavian bypass using prosthetic dacron has the risks of stroke, heart attack, damage to phrenal nerve to diaphragm, damage to auditory nerve, damage to thoracic lymph duct.
On the other hand, stent placement has the risk of clot going into and blocking the LIMA and thus putting life at risk. Also in-stent restenosis is another problem. Which is the better alternative in your opinion? What other associated risks are there?
Please reply urgently.
Alok