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My father(68) has under gone CAG & has been suggested bypass surgury. Kindly advice

My father(68) has undergone Coronary Angiography on 03-Mar-16. Report as mentioned below:
LMCA - Free of disease
LAD - 70% stenosis extending into origin of small D1
LCX - Co-dominant vessel with OM2 and distal LCX 50% bifurcation disease. OM1 large vessel with mid segment 70% stenosis.
RCA - Co-dominant and distal disease after crux tubular 90% stenosis.  
He is both diabetic and has hypertension.
Also note that during the Angiography he suffered a mild stroke.  

As per nurologist's advise he has undergone a Cerebral Angiography as well. Report as below:  
RCCA angio revealed a small plaque lesion in RICA
LCCA angio revealed an ulcerated plaque causing 60% stenisos of LICA & 90% stenosis of LECA with preserved distal flow.
Intra cranial flow was preserved LVA angio revealed normal VB circulation.  

Doctor has suggested bypass surgury.
Kindly advise.  
1 Responses
11548417 tn?1506080564
Dear Soura,
arteries can transport much more oxygenated blood than is necessary for the tissues that are fed from them, so they have actually quite some reserve capacity.. Therefore slight blockages do not give problems. Normally it are the 80+ % blockages that give the problems.
They can be bypassed with bypass surgery or they can be opened with stents in a minimally invasive angioplasty procedure.

Your father has one in the RCA after the crux. I think that surely needs treatment and at the moment will be the main cause of symptoms.
The other blockages are 70% or less and could perhaps be managed with medicines alone.

There are two scenario's:
-If your father would get surgery, they will probably, besides the problem in the RCA, also treat the other blockages in the LAD and RCX.
-If they would try to place a stent at the crux position and leave the other blockages as they are, that perhaps could be a good solution for the time being. The coming months would then show if that solution is good enough and durable.

If I was in your fathers position, I would certainly discuss the second scenario with the cardiologist as this means very short recovery compared to bypass surgery. The first scenario would still be possible afterwards if necessary.

hope this helps you a little. Please feel free to get back if you still have questions.

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