Angioplasty or Bypass Surgery

[Nilendu_Naharoy]

Dear Doctors,
My uncle was put on angiography and it revealed as under:

Cinical Diagnosis:

Diabetic Mllitus Type-II
Chest pain
Acute inferior Wall MI (Failed Thrombolysis)
Hypotension

Indication for Catheterisation:
Evaluation of Coronary Artery Disease.

Pressure:
AO: 90/70 mm of Hg.


1)  RCA : is anatomically dominant vessel and has 30-40% narrowing soon after origin with suggestion of thrombus and 100% occlusion with thrombus just after RV branch. Distal branches of RV branch are faitally seen during LCA injection.
2)  LCX : is anatomically non-dominnt vessel and has 80% mid segment stenosistrying to 100% occlusion last OM are filling antygradely. Last OM beyond A-V groom is thin.
3)  RI :  is a large vessel and has 80% occlusion in proximal segment at bifurcation. The upper branch is diffusely desease lower branch is a large branch and has 80% long segment proximal stenosis. Distally is graftable.
4) LAD :  is a type III vessel and has 70% long segment stenosis in proximal segment. Diagonals and septals are normal.
5) LMCA  : Long and normal.

Final Diagnosis:
Right dominant system.
Diffused Triple Vessel Coronary Artery Disease with Thrombolytic Occlusion of RCA.

please help me, as i am in a dilemma that should  we opt for angioplasty or bypass surgery.

[kenkeith]

Sorry to hear about your uncle's medical problem. The guidelines by AHA/AAC: recommend treating 70% or greater with medication if there is associated chest pain and relief, if pain is not relieved with mediction then a stent.  Sometimes a stent can not be successfully implanted due to location, size, configuration or an emergency heart attack.

It is difficult to assess your uncle's strengths and weaknesses in regard to the appropriate procedure based on the report posted.  For consideration, what is your uncle's general health?  Has medication failed to relieve symptoms?  Sometimes a thrombus can be dissolved with treatment, etc.