Confused

[Subha224]

My father, age 72 , diabetic had his angiogram done a week back. following are the results :

LMCA - Normal
LAD - type 3 vessel . Calcified vessel and has 70 - 80% lesion in the proximal and mid segments. Rest of LAD, diagonals and septal branches are normal
LCX- Small vessel. Diffusely diseased
RCA - Dominant vessel. Calcified vessel. Has 80% lesion in the mid segment. Rest of RCA and branches PDA and PLB are normal.
IMPRESSION : Triple vessel disease
Recommendation : Revascularization  or CABG or PTCA with stenting to LAD and RCA with Rotabulation atherectomy

Doctor says both the treatments are equally suitable.  If angioplasty, Rotational atherectomy must be done to remove the calcified area before stenting. We would like to know about the success rate of this procedure ( ROTA) as it appears to be a rare technique .
One more question, Regarding LCX which is diffusely diseased, The surgeon says it cannot be treated by either of the methods mentioned. Is it not possible to treat it via bypass along with other vessels? Whats the risk if its left that way without treating. Will it create any problem ?

[ed34]

Hi. Due to the age of your Father, I think I would consider the angioplasty more due to much less chance of infection and quick recovery. Stents still pose risks though because many block up again. I  have 10 and 5 have reblocked whereas the other 5 are still very clear. The ROTA procedure you mention is safe because it overcomes many other risks for Cardiologists. Many cardiologists will gently pick away at plaque and break the artery lining, whereas the ROTA system blasts plaque in front of it into tiny molecules which are naturally removed by the body. The only issue I can see is developing more plaque in a short space of time. If you imagine the inside of an artery, which has a glass like smoothness to the walls, this will be quite rough when plaque is removed. Unless they definitely only use the device where stents will be placed, I would ask more questions. Your Fathers artery layout is right dominant and he doesn't need to worry too much about the LCx. Either his left or right artery will likely open collateral vessels (natural bypasses) to feed to tissue on the rear left side of his heart. If the stents do block, then they could either put a new stent inside them, or consider bypass surgery. I would opt for the stenting to begin with.  He could last a few months or longer without any treatment, but as the blockages progress, options will become limited. Both his major vessels are badly diseased which means all supplies to his heart are compramised. Stenting is pain free and you are awake. It's actually good fun watching the cardiologist working on the monitors. I would however ask them to perform FFR after stenting. This just means they pass a tiny sensor down each artery to ensure a good flow of blood is present. I had a procedure where no blockage was visible but they did FFR and it showed a near total disruption to the flow. I had 2 stents and I immediately felt much better.

[ed34]

Hi, one thing to consider is your Fathers age. Imagine going through bypass surgery, a long recovery, just to find it hasn't worked. Bypass surgery is filled with risk, including infection or brain problems. If your father doesnt smoke, then I can't see stenting being too much of an issue but it still carries risks, but fewer then bypass. If this was my Father, I would suggest stenting and if this fails, further stents can be placed inside existing ones. If stenting becomes a nightmare with failures, then I would opt for bypass as a last resort. The problem with the LCx is that it is diffusely diseased. In other words, it is coated all the way along its length with disease. This means there are no clean areas to graft onto. Luckily, this is a small vessel and he could open collaterals to feed across into the heart muscle. If not, then I don't think a large area of heart muscle would be affected.