Triple Vessel Disease

[skgoyal]

I am 65 years male; patient of IHD for 12 years. Lipid profile was disturbed when disease was diagnosed. Underwent angioplasty of RCA which was 100% blocked in 1995. Second attempt with stenting was made in Dec.1995. Within 6 months the RCA restenosed. Underwent angiography in 2002 which showed 100% blocked RCA and a clear Left system. On CT angiography in September 2007 RCA was again blocked 100%, and left circumflex 30-40% blocked and LAD clear with insignificant scales. Blocked RCA is hard. Lipid profile is under control at present. How can this condition be managed? Is non-surgical option available? What will be the fatality of an attack in case circumflex is blocked? Should an attempt be made to open RCA? Is CABG recommended?

[Cleveland Clinic]

CABG is not recommended in the case of single vessel disease, unless this is the left main. An attempt to open the RCA should be made if you are having ischemic symptoms (chest pain, shortness of breath or arrhythmias), don't have good collateral network, and still have viable myocardium which is ischemic with stress in the distribution of the RCA.
CT angiography and a left heart catherization are not the same test so it is difficult to say if the disease progressed, or is just being over-read by the CT scan. Keep your blood pressure and lipids under control, exercise aerobically ( symptom limited,) stop any noxious habits ( smoking or chewing tobacco.)

[Healthyself2]

Your case is similar to mine.  My RCA has been 100% occluded for many years.  The interesting thing is that it has developed a nice little collateral network and the RCA fills pretty normally further downstream.  

I gave them two shots at opening it.  The first they couldn't get a wire in it and the second procedure was aborted when they discovered a ruptured plaque in my left main.   Anyway I had studied up pretty well on the whole situation and learned that the RCA is very prone to closing again after angioplasty or stenting.  

I finally decided to leave well enough alone, be happy, take my cholesterol and BP meds, and walk uphill every day.   That seems to have worked over the years as I can't detect any symptoms anymore.

I wouldn't worry about the anomoly in your circumflex.  Just attain and maintain a perfect lipid profile through multiple drugs if necessary and control your BP.  Those old artifacts (plaques) won't kill you as long as they are dry.  When the puss breaks out of a wet one, that's what hurts you.

Raising HDL is the key.  Since Phizer's new drug for that failed, we are only left with a sledge hammer - high dose Niacin, but it works well enough combined with exercise.  I've been on Niaspan for years along with Lipitor and Whelchol.  I figure that I've taken $58,000.00 worth of drugs in the last 8 years, but they have worked.  Just lucky to have a great liver!

As far as exercise, I highly recommend long duration, mild to moderate.  I walk about 3 miles per day and its a lot better if you have to go up and down hills.  I ski both cross country and downhill in the winter and take longer hikes in the mountains on weekends during the summer.  I don't do anything highly aerobic like running or playing tennis.

Be happy, don't worry and work on your HDL.

Good Luck