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64 slice cardiac ct angiography need advice
Sir
my age is 66 male i herewith enlclosing result of 64 slice cardiac ct angiography result kindly provide ur opnion what to do Iam a diabetic patient also.
70% stenosis of distal LMCA,80% stenosis of mid LAD, 100% stenosis of D1, 70%stenosis of origin and proximal ramus intermedius,Diffusely diseased with chronic subtotal occlusion of ostioproximal LCX, 95% stenosis of ostioproximal OM1, Diffusely diseased with 50% stenosis of RCA, 100% stenosis of PDA, Left dominant system.
thanks
ACLAL
my age is 66 male i herewith enlclosing result of 64 slice cardiac ct angiography result kindly provide ur opnion what to do Iam a diabetic patient also.
70% stenosis of distal LMCA,80% stenosis of mid LAD, 100% stenosis of D1, 70%stenosis of origin and proximal ramus intermedius,Diffusely diseased with chronic subtotal occlusion of ostioproximal LCX, 95% stenosis of ostioproximal OM1, Diffusely diseased with 50% stenosis of RCA, 100% stenosis of PDA, Left dominant system.
thanks
ACLAL
sir
Thanks for ur kind reply, what diest should be taken iam a diabetic also and i go to bypasss surgery or any alternative treatment is there
Thanks for ur kind reply, what diest should be taken iam a diabetic also and i go to bypasss surgery or any alternative treatment is there
Oh you have an extra artery, the ramus intermedius.
From your results I think it is likely you have some collateral feeds going on somewhere because the disease is quite significant.
On the left side, your left main coronary artery is 70% blocked and this vessel supplies all the left arteries from the aorta. Going down the left side, your LAD is 80% blocked, the Diagonal 1 is 100% blocked, the ramus is diffusely diseased (spread out), the left circumflex is 95% blocked at the obtuse marginal 1.
On the right your right coronary artery is 50% blocked. and the rear PDA is 100% blocked.
Personally I think you should have a nuclear scan to establish which areas need intervention because there are so many blockages. It could be that you have a whole network of collaterals which have opened up. However, my main concern would be the LMCA and it might be worth considering bypass at some stage to get around this issue, grafting using the LIMA vessel from your chest.
Have you been eating a bad diet for many years and had high blood pressure?
From your results I think it is likely you have some collateral feeds going on somewhere because the disease is quite significant.
On the left side, your left main coronary artery is 70% blocked and this vessel supplies all the left arteries from the aorta. Going down the left side, your LAD is 80% blocked, the Diagonal 1 is 100% blocked, the ramus is diffusely diseased (spread out), the left circumflex is 95% blocked at the obtuse marginal 1.
On the right your right coronary artery is 50% blocked. and the rear PDA is 100% blocked.
Personally I think you should have a nuclear scan to establish which areas need intervention because there are so many blockages. It could be that you have a whole network of collaterals which have opened up. However, my main concern would be the LMCA and it might be worth considering bypass at some stage to get around this issue, grafting using the LIMA vessel from your chest.
Have you been eating a bad diet for many years and had high blood pressure?
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What concerns me the most about your blockages is the LMCA, which is now 70%. It's right on the borderline for intervention. If you change your diet and avoid stress in your life, then there is a big chance that this disease will not get worse. It won't improve though, but you stop it progressing.
I don't believe you will find a cardiologist willing to stent so many blockages, but you never know. I think you would require the following intervention, if stenting is the option....
Stent LMCA, stent MIddle LAD, Stent top of LcX, stent the start of the Obtuse Marginal 1 vessel. So that's a minimum of 4 stents.
They would then have to establish what to do with the PDA and the Diagonal 1 because they are 100% blocked.
It doesn't look too bad when you look at individual vessels, but the location of three of the blockages makes stenting virtually impossible.
The bottom of the LMCA is diseased and where there is disease, the vessel splits into your ramus, LAD and LCX, it is the junction where those three vessels start, fed by the LMCA. The Disease from the LMCA is spread into the start of the ramus, restricting it, the disease is also spread into the start of the LCX, restricting that.
Even bypass would require a triple or quadruple. You would require a graft to the distal LAD, the distal and mid LCx and distal ramus.
I would have a blood cholesterol level test, and go on a strong diet for a few weeks. I hope they have put you on statin medication? this will help stop your vessels becoming inflamed and help stop the disease getting worse.
I would have regular cholesterol tests, probably once a month to start with, then when you have it as low as possible, have tests maybe once a year.
If you don't get your cholesterol LOW, then bypass surgery will really be a waste of time, the grafted vessels will block and the original arteries will also disease even more. What you put into your blood, will determine how long the vessels last.
Has your cardiologist recommended bypass? if so, how urgent do they believe it is? How bad are your symptoms?