multiple blocks in D1 and D2

[bsgurung]

What is the best option if there are multiple blocks in D1 and D2 arteries.. Angio plasty or Byepass ??

[bsgurung]

CT Coronary Angiography observation

LMA: Normal It seen bifurcation into LAD and circumflex.

LAD: Is type iii shows presence of mixed calcified and soft plaque in proximal part just beyond the origin causing 80- 90 % diameter stenosis.
Mid part between the origin of D1 and D2 shows irregular calibre with presence of multiple calcified and soft plaques causing 80 90 % diameter stenosis. Multiple soft plaques are noted in distal part causing significant multi focal 70 80 %diameter stenosis.

Diagonis : D1 is normal in calibre and opacification at origin with presence of a soft plaque is proximal part causing greater than 90 diameter stenosis.
D2 is irregular with presence of multiple soft plaques along its course causing 60 70 %diameter stenosis.
D3 is small

Left circumflex: Normal in course and calibre . no significant stenosis / plaque is seen.
Obtuse Marginals : OMI is normal.
RCA: Stent is noted in proximal part with normal contrast opacification distal to stent, Acute marginal is normal in course and calibre.
Distal RCA is seen bifurcation into small PDA and PLV.
Dominance Right

Left ventricular ejection fraction is 63 %
Impression : Findinfs are s/o post PTCA patient with patent stent in RCA with severe disease in LAD involving entire course.
PLEASE ADVICE WHAT STEP TO TAKE , WHETHER ANGIO PLASTY OR BY PASS?

[CCF HeartMD6]

This is a difficult question to answer just based on a report.  Bypass surgery is often times recommended for a number of reasons including when there are occlusions in multiple vessels (often times including the left anterior descending artery).  However, there are many factors that come into play including whether there are suitable targets (good location for a bypass graft with no further disease distally), the location of the occlusions, the size of the vessels affected, the amount of myocardium affected by the occluded vessels, and the candidacy of the patient for either angioplasty/stent or bypass surgery (including patient preference).  The best way to address this question is to have an interventional cardiologist look at the actual angiogram in conjunction with a complete history and physical examination.