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Urgent advice needed for a heart patient

A few weeks ago, my brother underwent a stroke and did the cardiac stress test later which was good. But, as he still had a pain in his chest, he underwent an angiogram too.

Following is the report of the angiogram.

LMCA : Normal
LAD : Diffuse disease throughout, 40% proximally, 70% lesion just before D1, 99% lesion distally
LCX : Large Dominant minor plaque distally, OM1/OM2-small mild disease, OM3-Large, minor plaque
RCA : Non-dominant, small vessel, 99% lesion distally
Conclusion : Double vessel disease
Recommendation : For optimal medical treatment in view of diffuse LAD disease

Along with the report we met a few doctors and following are the statements made by each doctor.

1. Neither stenting nor bypass can be done, but at a high risk of another stroke and live is in danger. He also said undergoing a bypass would be useless as well.
2. Stenting can be done(3 stents), but cannot guarantee the success
3. Undergo a bypass
4. Try to control through medicine and strict diet for a year, do an angiogram again and check the progress and decide
5. Since cardiac stress test was alright, can be controlled through medicine and strict diet

As the statements are contradicting, I am helpless about the best option for him. Hence, I greatly appreciate if anyone can be kind enough to share their experiences, advices with me to save his life.

Please also note that, he was smoking until he got the stroke, but now he has completely got away from it.

Angiogram report can be found at following links.

[1] http://i.imgur.com/qZaCuzq.jpg
[2] http://i.imgur.com/nYK3h5p.jpg
[3] https://www.youtube.com/playlist?list=PLqbr9TO4USsvqiE4Z2EP-OR8BUAje9xtv
2 Responses
11548417 tn?1506080564
If I was in your brother's position I would probably go for the 3 stents AND a strict diet + medicin. See how this works out and keep the bypass surgery as a reserve option.
It seems to me your brother needs a quick solution for the 3 serious blockages, which could be given by the stents. The other problem areas could be treated with medicins and healthy diet.
This would imo be in concordance of statements 2, 4 and 5.

Good luck to your brother
976897 tn?1379167602
I would go for option 6 which isn't suggested. I would have a stent in the 99% blockage in the RCA. I would leave others for a year and stay away from cigarettes and go on a strict diet change. I think he will open collateral vessels from the LCx to feed tissue fed by the bottom of the LAD. Have an angiogram in a years time to see how things are going. They obviously need to do a good stenting job on the RCA because you want good results on this. Don't worry about another stroke, the meds will greatly reduce the risk. Has his carotid arteries been scanned? the ones in the neck which feed the brain etc?
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159619 tn?1538180937
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