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Coronary CT Angiogram
From Irshad Khan, New Delhi, India
I have taken last week CT Angiogram and its findings are worrisome. The main impressions are:
Calcium score: 18, Soft plaques seen in proximal LAD and D1 segment.
LEFT CORONARY ARTERY
LM - Normal
LAD - (Prox/Middle/Distal)- Type -III LAD with normal course. Focal Eccentric non-calcified plaque seen with moderate luminal narrowing.
Diagonals----
D1 ----- Single large D1 branch seen with normal course. Mid vessel reveal plaquing with moderate luminal narowing.
Obtuse Marginal Branches
OM1 --- Normal
OM 2 --- Large OM2 artery seen with distal branching. Proximal vessel reveal focal luminal narrowing with approx 60-65 % stenosis.
Please advise me what course of treatment is advisable.
I have taken last week CT Angiogram and its findings are worrisome. The main impressions are:
Calcium score: 18, Soft plaques seen in proximal LAD and D1 segment.
LEFT CORONARY ARTERY
LM - Normal
LAD - (Prox/Middle/Distal)- Type -III LAD with normal course. Focal Eccentric non-calcified plaque seen with moderate luminal narrowing.
Diagonals----
D1 ----- Single large D1 branch seen with normal course. Mid vessel reveal plaquing with moderate luminal narowing.
Obtuse Marginal Branches
OM1 --- Normal
OM 2 --- Large OM2 artery seen with distal branching. Proximal vessel reveal focal luminal narrowing with approx 60-65 % stenosis.
Please advise me what course of treatment is advisable.
I saw my Cardiologist yesterday morning for a checkup and he showed me my angiogram from March, when I had MI. He showed me where they put the 2 stents (which I knew anyway) and then pointed out another blockage which they had missed.
I explained that I feel better now than I have for years, but his professional opinion is that this blockage will have already grown and will continue to grow. He wants to do an angiogram and if it's fairly large, he wants to stent it.
Do I believe him when he says the blockage will have grown and will continue to? yes. My history has proved this many times so I don't doubt it. Will I have the angiography? yes. I want to keep my Circumflex clear in case any of the many stents in my LAD block. That way I will have a good source to form collaterals if and when the time comes.
I know there is a tiny risk associated with angiography, but I will take a bet with anyone that I will be here typing soon after the procedure :)
I explained that I feel better now than I have for years, but his professional opinion is that this blockage will have already grown and will continue to grow. He wants to do an angiogram and if it's fairly large, he wants to stent it.
Do I believe him when he says the blockage will have grown and will continue to? yes. My history has proved this many times so I don't doubt it. Will I have the angiography? yes. I want to keep my Circumflex clear in case any of the many stents in my LAD block. That way I will have a good source to form collaterals if and when the time comes.
I know there is a tiny risk associated with angiography, but I will take a bet with anyone that I will be here typing soon after the procedure :)
Hi
Wow, is the first word which I think of. It really is hard to imagine two things here. First that you have no symptoms, even with medication AND how are your collaterals getting enough flow? Your left circumflex is severely blocked at the beginning (80% min), your LAD is severely blocked at the beginning (90%), your RCA is severely blocked at the beginning (90%). So how are you getting enough flow from anywhere to keep the collaterals open?
I know we see things differently, with different opinions, but if this was my heart I would be having a bypass. The minimum bypass I would have is to get a feed into the left circumflex because this is likely to be the vessel doing all the work through collateral feeds. Personally, I believe that if this vessel becomes more blocked, collaterals will start to close down, removing feeds to the RCA and LAD.
Has your Cardiologist told you which vessel is feeding your collaterals?
Again I have to say WOW, I think you are doing amazingly well.
Wow, is the first word which I think of. It really is hard to imagine two things here. First that you have no symptoms, even with medication AND how are your collaterals getting enough flow? Your left circumflex is severely blocked at the beginning (80% min), your LAD is severely blocked at the beginning (90%), your RCA is severely blocked at the beginning (90%). So how are you getting enough flow from anywhere to keep the collaterals open?
I know we see things differently, with different opinions, but if this was my heart I would be having a bypass. The minimum bypass I would have is to get a feed into the left circumflex because this is likely to be the vessel doing all the work through collateral feeds. Personally, I believe that if this vessel becomes more blocked, collaterals will start to close down, removing feeds to the RCA and LAD.
Has your Cardiologist told you which vessel is feeding your collaterals?
Again I have to say WOW, I think you are doing amazingly well.
In continuation - I doubted the results of the test and therefore decided to go for the same test again by some other doctor and after about two to three years. Other tests are of no much use to me. at present I am very much ok on medicines only for about an year. i would like to know your advice. thank you.
your August 11 ,2011,10.16 AM post - You have perfectly understood my case. That is exactly I am doing now. No further test is of any purpose. I wonder how following blockages are shown on angiogram.
Left anterior descending artery -The proximal LAD has a 90% long segmentlesion followed by a 80% short segment lesion.The mid LAD has a 60% long segment lesion. D1 and D2 are diseased.
Left circumflex artery - The ostial LCx has a 80% excentric lesion.
Right coronary artery - The proximal RCA has a 90% short segment lesion followed by a 90% long segment lesion in its mid segment. the distal RCA is diseased.
Coclusion - Three vessle coronary artery disease.
Left anterior descending artery -The proximal LAD has a 90% long segmentlesion followed by a 80% short segment lesion.The mid LAD has a 60% long segment lesion. D1 and D2 are diseased.
Left circumflex artery - The ostial LCx has a 80% excentric lesion.
Right coronary artery - The proximal RCA has a 90% short segment lesion followed by a 90% long segment lesion in its mid segment. the distal RCA is diseased.
Coclusion - Three vessle coronary artery disease.
Sorry, I didn't answer your question to me shown on the other post and you do have the advantage of my prior answer... (: My answer is NO, why would you even ask, it doesn't make sense to me, so please restate and you may change your question now that you had read my prior post to your other questions or do you still not understand? I wish I could draw a picture for you or you could draw onbe for me?.You can build on the information from my prior post because it does, in effect, answer the question if you understand . I just don't know
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