Bypass Vs. Stenting

[deven349]

My dad has been diagnosed with blockages in heart.  He has diabetes (approx range: 140 - 280).  He has blood pressure (approx: 160-170 / 85-90).  He is 73 years.  I would appreciate it if you could advise as to what should be done:  bypass or angioplasty stenting?

Left Main : Normal .
LAD : Calcified vessels. The LAD proximal has a smooth 80% lesion,  distal LAD is normal
LCx : Large dominant vessel with a proximal 75% lesion . The OMI has
multiple branches with a long 60 to 70% lesion, distal PDA is normal.
RCA : Non-dominant.
LIMA / RIMA : Normal.
LVEF good on 2D echo.
Left renal artery : Has a 60 % lesion .
Right renal artery : Has a 80% lesion.

I can also mail the CD of the angiography if you want to look at it.  I have attached in a word file, the picture of the heart, location and % of the blocks, neck vessel / carotid doppler test report, and renal scan - kidney reports.

[deven349]

Thanks for your suggestions.

[Sweetwaterguy]

Kenkeith has offered  excellent information.  Stents and bypass can be life savers when it is absolutely indicated, and most often that involves emergency situations.  My cardiologists have told me that stents to not increase longevity.  People tend to live as long when treated with medications as the would if they were stented.  In my particular case, they told me that if my blockages get worse and it affects my active quality of life--chest pain, shortness of breath, stamina etc., then I might want to consider a stent.  
    My suggestion is to have this conversation with your father's doctors.   They are in the best position to evaluate all the information and explain the options.  Keep in mind, sometimes there are no options and stents or bypass is unavoidable.  

[kenkeith]

My response is to seriously consider just medication unless medication does not relieve symptoms and specifically angina (chest pain).  You can google the COURAGE study, and you will read the recent scientific study shows there is no difference in longivity with medication, stent, or bypass.  

An interventional cardiologist who follows aca/aha guidelines wouldn't stent any lesions that are less than 70% (possible exceptions).  Diabetes complicates the issue both in terms of medication (may not be effective or contraindicated) and surgery.  Diabetes is a factor that should be considered.  I assume LVED is greater than 55%.

For almost 4 years, I have been on a medication regimen and no symptoms..feel fine every day.  At the time I was hospitalized for congested heart failure, EF was 29-13%, 100% blockage of the LAD (remains blocked but collateral vessels growth have provided a natural bypass, the LCx is/was 72% blocked (not stented) and the RCA 98% blocked and stented to help provide additional blood to the distal portion of the heart due to blocked LAD.  Also, mitral valve regurgitation.

Regardless there should be medication for the high blood pressure and cholesterol.  Everything considered the report isn't that bad, especially with a good LVEF and when eliminating lesions less than 70%.