Angiogram Report advice needed

[rajahassan27]

Hi Need your advise based on Coronary Angiogram Report.
Age 52

Angiogram information

LMCA: Normal.

LAD:    TypeIII vessel, proximal diffuse calcified lesion with 90% luminal narrowing in tighest portion, lesion extends into mid segment. Distal LAD normal.

DIAGONAL:D1 and D2: Normal

LCX: Non Dominant system, normal.

OMs: OM1: Fair sized vessel, proximal 70% lesion. OM2: Fair sized vessel, normal.

RCA: Dominant system, proximal sub total occlusion. Antegrade bridging collaterals+. PDA and PLVB filling R/G from left system.

ANGI  Not Done.

CATH DIAGNOSIS #CAD:Triple vessel disease

CATH ADVISE CABGS.

Your advise will be helpfull in making a decision.

[ed34]

" If inspite of medicine and stenting chaste pain can not be managed then bypass is last resort"

How can a bypass be the last resort? this means there are no alternatives and we have to give up, and this simply isn't the case. Maybe you just didn't choose your words wisely, but this could make people believe their bypass is the end of the line and there are no other avenues for them if something goes wrong, or they are not ideal to have a bypass in the first place.
So just to clarify and put some minds at ease, bypass is not the last/only resort if stents cannot be done or they fail.

[nagrajjain]

If chaste pain can be managed by medicine no-stenting and no-bypass. If chaste pain can be managed by stenting no bypass. If inspite of medicine and stenting chaste pain can not be managed then bypass is last resort. Do you have chaste pain at rest or on exersion?

[ed34]

"it appears the LAD should be stented"

I couldn't disagree more. The disease is from the top of the vessel to around half way down, which would require end to end stenting. This has very little success due to restenosis. If the distal LAD is normal, which the report states it is, then bypass would be ideal. I totally agree with the post by cecilea.

[subham89]

my mother is having a LAD 90%BLOCK THE DOCTOR ADVICE FOR DES STENTING PLEASE SUGGEST

SUBHAM DEY

[kenkeith]

I had triple vessel disease 6 1/2 years ago.  The RCA was stented, circumflex 72% left as is and 100% blocked LAD.  I have had no problems and only take a nitrate prior to going to the gym for a workout 3 times a week.

For rajahassan, it appears the LAD should be stented.  OM1 nothing, and RCA questionable based on collaterals and total blockage.  

[cecilea]

As you've triple vessel disease, CABG is the only choice as three arteries have to be stented. Stenting is the choice for single or double vessel disease. Also in your case, the LAD which is blocked from proxymal to middle segment can't be stented due to the length of blockage.  

[kenkeith]

Usually, when there is an angiogram (cath) there is a stent implant if needed.  It seems based on the angiogram it is recommended to do a bypass. It is not clear by the information from your post why there wan't any implants?  That is a question only your doctor can answer, and your post does indicate triple vessel disease...the geometry of your heart's vessels, location of the lesions, size of the lesions can be the reasons for not stenting!

Your symptoms and ineffective response to medication would/should be considered before CABG.  I have a totally blocked LAD (has collateral vessels for a natural bypass) and 72% blockage of another coronary vessel , and for the past 6 years I have been treated medically.  I feel well and have no symptoms.  The ACE inhibitor drug dilates the vessel sufficiently enough to supply ample blood/oxygen to all areas of the heart.  With my exercise routine 3 times a week, I take a nitrate prior to the workout...no problems with a moderate exercise routine.