LMCA and OM1

[sathya946]

my father is 78 yrs old with type II DM . recently diagnosed with 70% LMCA stenosis and 85% OM1  stenosis.
what is the best treatment option to undergo at his age. (Stent or CABG or Angioplasty?)

thanks

Sathya

[Flycaster305]

I'm guessing that the diagnosis was made from a stress test.  The usual protocol is to have an Endoscopy which is the gold standard and much more accurate way to map heart artery blockages, and as Ed suggests either stenting or bypass is determined from an angiography.

I agree with Ed completely, he and I have had multiple stents and also bypass surgery, stents are much, much less invasive.  That said, stents can't always be used to solve the problem, and bypass could be recommended.  

Regardless of what happens, tight diabetes control, diet, exercise and good medications are extremely important going forward.

[ed34]

First off, Angioplasty is a procedure which includes stenting as an option. The decision is not just based on the size of the blockage unfortunately. There are things which need to be taken into consideration, such as how calcified the blockage is. The location is also a contender. There are obvious benefits with Stenting over bypass, such as much less discomfort and a much faster recovery time but it could all be a waste of time if chosen when the best option is bypass. Vice versa also counts.
There is a lot of data regarding stenting for Cardiologists to study and pick the best solution, it isn't simply a toss of a coin. For example, the location of the blockage could be near a bifurcation (a junction where two arteries branch from each other). It is obvious from history that treating such blockages (sometimes called ostial) very often results in a re-blockage in the same area from scar tissue even if drug coated stents are used. Heavily calcified blockages also tend to re-block more than softer plaque types.
Looking at your Fathers report, there is a major issue, the LMCA. The left main coronary artery (often called the left main stem) supplies the Left anterior descending and the Left circumflex, which both feed the left ventricle and usually the septum dividing the left/right ventricle. The obtuse marginal one, is a vessel down the Left circumflex , fed by the left main stem. The left main stem is important to clear up and have good flow. The obtuse marginal one also feeds a good proportion of heart muscle and can cause bad angina when blocked this much.
I think, even though there is a risk of re-blocking if high calcium or location are not ideal, if it was my Father, and gien his age, I would push for angioplasty. I would want this for the main reason of much less traumatic surgery and much less risk of infection.