is this patient suitable for angioplasty?

[Pankaj249]

My Dad used to have chest pain even after walking 10 steps. He reported to the hospital and angiogram was scheduled. But it took 3 days for angiogram to take place as we were told that he has low platelets and 3 SDPs were given to him. His platelets count was arnd 18k. After SDP it went up to 70-80k. After this angiogram was done and below are the details:

Origin         :- Normal
Dominance :- RCA
LMCA        :- Normal
LAD :- 100% proximal stenosis  (LAD is retrograde filling from RCA)
LCX :- 90% ostial stenosis
RCA :- 40% mid stenosis
RI :- 80% ostial stenosis

Doctor performed the Angioplasty(after giving 4 more units of SDPs in later days) and implanted 2 medicated stents in LCX & RI.

My dad was fine for 3 months but later on he reported the chest pain again with mild physical works like walking 1-2 steps etc. We reported to the hospital and an angiogram was again performed to find the below details:

Origin         :- Normal
Dominance :- RCA
LMCA        :- Normal
LAD :- 100% proximal stenosis  (LAD is retrograde filling from RCA)
LCX :- 90% ostial stenosis
RCA :- 40% mid stenosis
RI :- 50% ostial stenosis

This time the doctor adviced CABG./ REVASCULARIZATION. CABG was performed and below are the procedure details:

OPCAB X 3 : LIMA to LAD, RSVG to RI, RSVG to OMI through Sternotomy

CABG was performed in a hospital different from the one which performed Angioplasty.

The doctor in the second hospital told me that this was the case of CABG at the first attempt and the angioplasty was not suitable for my Dad. Was the first hospital wrong?

Also, the second hospital took only one SDP and performed Bypass.

[Pankaj249]

Thanks for the sincere reply.

[kenkeith]

Assume there is  non-surgical bleeding due to thrombocytopenia (a defiency of thromboplastin in the blood)....If possible, prior to transfusion the reason for thrombocytopenia should be established, identified and corrected, if possible, prior to surgery. Platelet transfusion is indicated only if the defect cannot be otherwise corrected: for example, a congenital platelet abnormality. Consultation with the blood bank physician is recommended in these situations when thrombocytopenia is caused by marrow failure, the following transfusion triggers are considered appropriate: Bleeding with qualitative platelet defect documented by history and/or laboratory tests. With that said:

For 18K... Affirmative for treatment if platelet count is between 10,000 and 20,000/mL and coagulation abnormalities exist or there are extensive petechiae or ecchymoses.... During neurosurgical and ophthamologic procedures some authorities recommend that the platelet count be maintained between 70,000 and 100,000/mL. I assume platelet count and coagulation studies was performed prior to the transfusion to guide subsequent therapy. During surgery on patients with quantitative or qualitative platelet defects, the adequacy of hemostasis in patients should be evaluated by the assessment of microvascular bleeding.

QUOTE: "Also, the second hospital took only one SDP and performed Bypass"

...A typical platelet transfusion dose is 1 SDP or 4-5 pooled RDP. This should raise the platelet count of a typical 70 kg man approximately 30,000-50,000/mL. There are considerations...Platelet count increments after transfusion may be lower than expected in the presence of certain medications, fever, splenomegaly, infection, or alloimmunization to HLA or specific platelet antigens. I assume there was consultation with the Blood Bank/Transfusion Medicine physician or Hematologist for your father's specific condition.
___________________________________________________________

QUOTE: "The doctor in the second hospital told me that this was the case of CABG at the first attempt and the angioplasty was not suitable for my Dad. Was the first hospital wrong? "
_____________________________________________________________
For some insight...Studies indicated that use of the left internal mammary artery (LIMA) to the left anterior descending (LAD) artery, as well as obtaining complete revascularization, significantly impacted on long term survival.  
  
In general, those patients with left main disease, and patients with significant two- and three- vessel disease with depressed ventricular function were found to have improved long term survival with surgery. I have a totally blocked LAD 100% proximal stenosis  (LAD is retrograde filling from RCA) and collateral bypass.  The RCA was stented to provide more blood to the deficit location from occluded LAD.  I have no problems with mediction.

Single-vessel coronary artery disease is usually treated with PTCA (stent); the second opinion may take the approach when applied to the left anterior descending coronary artery (LAD) is hampered by high restenosis rates, often approaching 50%. Coronary stenting (STENT) and left internal mammary artery bypass grafting of the LAD (LIMA-LAD) are other options that have been successfully used for single-vessel LAD disease. The optimal mode of revascularization for patients with isolated single-vessel LAD disease is unclear.

"The purpose of the present study was to examine PTCA versus STENT versus LIMA-LAD with respect to short- and intermediate-term outcomes.
Conclusions—Revascularization for isolated LAD disease using PTCA, STENT, or LIMA-LAD results in low in-hospital adverse event rates and good long-term results. Repeat procedures are required less often after LIMA-LAD than after either PTCA or STENT. Long-term mortality was not statistically different, but the trend was for the lowest mortality with LIMA-LAD, a somewhat higher mortality with STENT, and the highest mortality with PTCA.

There a different opinions regarding stents, cabg, and medication to treat blocked arteries.  I am successfully treated with medication by a non-interventional cardiologist.

Your dad's operation consisted left internal mammary artery grafted to the LAD (left ascending artery), veins harvested from the legs were grafted to RI and OMI (old myocardial infraction.