Triple Vessel Disease - Need Help

[suri111]

Hi, I need some help please. My uncle is 55 years old.

He is diagnosed with Triple Vessel disease.
SOB (Angina equivalent).- FC III X 15 days. Good LV Function. HTN, DM

His report shows:
ECG :  NSR, LAE+ St Depression with T Inv In I, Avl V4-V6
ECHO: No RWMA, Good LV Function
LMCA : Normal
LAD:  Type III Vessel proximal LAD 90% eccentric disease.
LCX: Non-Dominant, LCX continue to major OMI, mid 80% disease
RCA: Dominant Normal.
PDA and PLV:  IInd PLV has tight ostial stenosis.

General :  Pulse = 70beats/min
B P : 130/90mm Hg
CVS:  S1, S2 Normal
Chest: Clear

Risk Factor: DM & HTM
Recommendation : Early CABG

I just want to know weather we should have him go for CABG or there is another alternative than can be done.
Also, is CABG safe and reliable medium of treatment. Please respond.

[ed34]

From my own experience, I seem to have a different view. I am of the opinion that stenting should be used first and if this turns out to be a failure, then bypass. Stenting carries less risk because it is far less invasive, giving virtually zero chance of infection and an almost instant recovery in comparison to bypass. When matched to bypass, stenting is on equal ground with risks with stroke or heart attack during the procedure. I had a triple bypass in Sept 2007 and in December 2007 it failed, the bypass grafts closed. When in hospital I was just shocked to see how many other patients suffered the same fate. Some only saw their bypass last 2 weeks. You must remember that the Cardiologist who did the Angiogram has likely based his opinion on his own experience. If he isn't confident about stenting in those areas, then there are plenty who are. Certainly the OM1 (obtuse marginal 1) is not a problem area for stenting. I have 2 stents there, which are fully open from 2007. The LAD is what seems to scare some cardiologists for some reason.

[Paderla Anitha, DNB]

Hi, stenosis of LAD greater than 70% is an indication for Coronary Artery Bypass Grafting. He also has blocks in the LCX. So, surgery may be the option. This may again depend on his clinical symptoms and his general health condition. Good luck with his therapy.