Diseasesd Coronary artery

[popy1980]

My father is 63 years of age . his angiogram was done on 07.12.2010.  According to the CAG report:

LMCA : Free of diseases
LAD:  Having 80-90% stenosis in its proximal segment.
LCX: having 90-95% stenosis in its proximal segment
RCA: Dominant vessesl ^ totally occuluded in its proximal segment . Distal RCA, PDA and PLV braches are filled by ipsi and contra lateral collaterals.


Comment: coronary artery disease (TVD)

Recommendation: CABG/ PCI to LAD ,LCX and RCA.

Will you suggest me what would be better for him?

[kenkeith]

Almost 7 years ago now, I had/have a totally blocked LAD, LCX 70% occlusion no treatment, and an RCA 98% blocked and stented.  

It is important that your father's symtoms be controlled, and that can be done with medication (diltates vessels for a better blood flow), if medication doesn't provide releif from symptoms, then a stent.  If a stent cannot be implanted due to location, length of occlusion, etc. then CABG.  AHA/AAC has the position there is no difference with which treatment for longivity...about the same.  

Your father has a RCA dominant configuration of that vessel that indicates it feeds into the bottom portion of the heart and around into left side as well.  Obviously the total occlusion has develeped collaterals.  The presence of collaterals, and their anatomical distribution and functional adequacy, are important factors when considering PCI, as successful PCI has a fairly high chance of resulting in loss of collateral artery flow.
That is an important consideration, and after 6 years of reading and answering heart related questions (approx. 10000), I read many related posts and have an opinion that many individuals that have a stent implant in short time require more stents or a CABG because the gradient pressure on other segments of the blood vessel configuration are effected by the stented opening of a prior occlusion.

It appears your father has developed good collateral blood flow, and it may take a very good surgeon or cardiologist to proper analyze the overall effect of opening any occlusions that have good collateral flow.

A decision may be based on how well your father has been doing up to this point in time.  What has been the treatment, and concomitant health issues, tests, medication, etc.  To make a blanket statement regarding treatment just based on vessel blockages does not have much credibility and does not serve your father well..

If you have further information, any questions or comments you are welcome to respond.  Thanks for the questions, take care.

[ed34]

Bypass surgery has come a long way since the 70's and the techniques used certainly make the surgery less risky. However, there are bypasses and there are bypasses. The usual choice the surgeon makes is to graft an Artery from the chest into the LAD and then use harvested veins from legs to do the other grafts. The problem is, Arteries last a lot longer than veins and there is no guarantee how long the veins will last. Mine lasted three months, but I've met a whole range of people who have had them last from two weeks to 20 years. No one can tell you how long the veins will last and no one can tell you why they last longer in some patients than others. There are 2 Arteries which can be used from the chest, but it depends on their condition. If they are no giving a very good blood flow, then it's not worth using them.
Bypass surgery is not without a long recovery and discomfort and I can say from experience it's very disappointing to go through all that for it to fail. I believe the 'expected' life for vein grafts is around 15-20 years, which is what I was told in 2007. I was 47 and so could expect further surgery before the age of 67. Like I said though, some people have bypass surgery and feel great for many years, but it's the not knowing if you are one of them.
After my bypass failed, it was decided that the only remaining option was stenting. So, I've had both done to the same vessel. The stenting procedure was done by a very experienced cardiologist, I ensured that. He has over 30 years experience and fitted the first stent here in the UK. Having a well experienced cardiologist doing the procedure obviously reduces the risks considerably. The risks associated with stenting are puncturing the vessel wall with the catheter, but this is rare and usually occurs more with blockages of 100% because it's harder to get the thin wire past the plaque. There is a risk of stroke or heart attack, but with todays techniques it's a very low risk, I would say probably lower then that in bypass surgery because safety nets can be used to catch large pieces of debris. There is also the possibility of a re-blockage in the stent, but with drub eluting stents and medication this is very low in risk and a good cardiologist will know the best brand of stent to use, with the best track records. Recovery with stenting is very quick, after my 6 stents were inserted into the LAD, I was discharged the following morning with just a slight ache in the top of my leg (entry site). Another thing to consider is that during bypass procedure, you are already in a theatre, equipped to deal with all kinds of mishaps. In a Cat Lab, you have to be wheeled to a theatre, and wait for cardiac surgeons to scrub in etc. There is a higher chance of infection with bypass surgery, the surgery is very invasive. The forming of blockages can still occur in bypass vessels, but usually these can be stented, unless they completely collapse as veins can. This is certainly a very difficult choice to make due to the pros and cons and risks. I know which I would choose but really it isn't my place to say, you have to speak to your cardiologist and go through all the details.
I wish you luck and I'm sure whichever choice you come to, it will be the right one.