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Angioplast Vs CABG

In the recent catheraization, it is found that RCA with distal total occulsion and in addition 70% lesion in proximal LCX and mid LAD. Kindly advise me whether to go for CABG or for PCI of LAD and LCX.

Ramana
1 Responses
367994 tn?1304953593
More than 4 years ago I had a stent implant of RCA (98% occluded)...LAD is totally blocked (collateral vessels developed and provide a natural bypass) and LCX 72% occluded unstented  Medication, exercise and a healthy diet, etc. has been successful in returning me to good health after congested heart failure and severe mital valve regurgitation.

My answer to your question is to go with non-intervention regimen (medication, etc.) before considering a stent.  Open heart surgery and bypass may not be necessary.  

There are recent studies that support the medication option:  COURAGE study,
"In the trial, 2,287 patients — who were in stable condition but had significant buildup of plaque in one or more arteries around the heart — were randomly assigned to two groups. One group received angioplasty and stenting plus treatment with drugs; the other received drugs alone. They were followed for a median of 4.6 years. Those who received stents did not show a reduction the risk of heart attack, hospitalization for acute coronary syndrome, or the composite of heart attack, stroke and death, but they did have a greater reduction in chest pain than those who received medical therapy alone".  

Cardiac revascularization procedure such as bypass or stenting are not performed to reduce the risk of death, but reduce the intolerable chest pain (angina) of untreated CAD and often intolerable effects of mult-drug regimens used to manage the condition without invasive procedure.  There are other recent studies to support.

Recently, there has been some bad news regarding drug eluding stents (coated to help prevent repeat occlusion) as many patients experienced clotting within a year or so and required further intervention.  CABG sometimes requires another operation as the bypass itself develops blockage (especially if vessel is harvested from the leg).

What are your symptoms?  Why has medication, etc. been ruled out as an option?



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