Total occlusion in RCA ..panicked help!!!1

[kamal146]

Recently i underwent Angiography and was diagonised with blockages as follows
LAD : Focal minor lesion just before origin of D1 and focal significant lesion in very distal part
LCX : short segment significant lesion in proximal part at OM1
RCA : Dominant total occlusion in proximal part faint antegrade filling.
Had gone for angioplasty twice
First time astent was placed in LCX but could not open RCA as i started shivering.
At second attempt after 2 weeks from first, doctor tried to open RCA, angioplasty lasted for  5 hours but the wire could not pass through so could open RCA ,so he placed a stent at LAD which was 40% blocked. what should i do?
Do i hve to go for open heart surgery or can i live with the block in RCA. is block in RCA life threating.

[ed34]

Your LAD and Obtuse marginal 1 have been re-opened. Your RCA is blocked in the distal section but has faint retrograde filling. This is through adaptations, collaterals. I would leave as is. The left side sounds fine after stenting, and the right side is not really suffering, so I would just see if more collaterals open up should the demand rise.

[pauly1962]

Forgot to mention, angioplasty done based on abnormal EKG and blockage indicated during stress test.

[pauly1962]

I'd very much like to hear how you have been doing. I just discovered I have a totally occluded RCA myself. I have only had one angioplasty at this point. Likewise the surgeon was not able to pass the wire through the RCA, apparently considerable scar tissue has developed. My angioplasty only lasted 1 hour. Remaining arteries are essentially clear. Considerable collateral formations have been observed.

[padoor]

you did not specify this angiogram was done because of a small infarction or just for some other symptoms. your age and other health conditions are needed for further opinions.
i have a 100% back coronary block for last 20yrs.40% block on right coronary and colatteral formations observed.
i am on continuous medications and ok for most times.

[kenkeith]

The American Hospital Association/American Academy of Cardiology give guidelines for intervention for CAD.  The guidelines are to avoid interventional procedures (stent, by-pass) for any lesion less than 70%, unless there is pain that cannot be controlled with medication.  That same recommendation can be applied to lesions greater than 70%.

To state as your report does, "significant lesions" is incomplete, possibly misleading and not much help when reviewing or judging.

I have a totally blocked 100% LAD (4 years now) and I do well with medication.  It happens other vessels develop and feed into the oxygen deficit area with colateral vessels.  I do well with medication.

It is possible the 40% LAD did not need a stent according to AHA/ACC guidelines (but there are exceptions?!)  Your totally blocked RCA may have been by-passed with colaterals and opening the RCA now would not be very beneficial.  

Symptoms and control of symptoms would be the deciding factor.  If you have a totally blocked RCA and no symptoms, it is probable the area below the blocked area is getting sufficient blood/oxygen.

You should get a second opinion!!