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What Does This Angiogram Report Indicate?

Posted on Mon, 7 Sep 2015

Question: Sir/Madam, my dad underwent angiogram and following is the finding:
Left Main Coronary Artery is normal with distal trifurcation.
LAD is a type III vessel with proximal long segment bifurcation with Diagonal - 70%-80% stenosis. Mid and distal LAD and the septal perforators are normal. The diagonal artery has ostial - 70% stenosis and is a 2.50mm vessel.
The doctor recommeneded bye-pass surgery more than angioplasty. I wanted to check why angioplasty wont be sufficient for my dad. Pls help. He is a diabetic and has BP but he did not have any major chest pain --- only a chest discomfort.

Answered by Dr. Priyank Mody (2 hours later)

Brief Answer:
Angioplasty is a viable option

Detailed Answer:
Respected mam, I am Dr Mody and I would be addressing your concern.
I have gone through the Angiogram, for sure angioplasty can be offered to your father with equivalent if not superior results as compared to the bypass, however it is a bifurcation lesion and so two stents will be needed and the doctor should be skilled enough in bifurcation lesion, If you are based in XXXXXXX Dr XXXXXXX XXXXXXX is the best doctor who can do in in XXXXXXX he is appolo XXXXXXX second option would be Dr Ajit mullasari in madras medical mission.
I am pretty confident about a successful angioplasty
Also I would be more happy if you can send me all relevant investigation so I can balance my choice.
Regards Dr Priyank Mody, Lilavati Hospital, XXXXXXX

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Priyank Mody (1 hour later)

Thanks Dr XXXXXXX for your detailed reply.
I have enclosed the ECG, Echo & treadmill tests taken. Pls excuse me if the test results are not fully & properly clear. I have tried to make it as clear as possible.

Pls also note the following:
1. My dad is 69 years old
2. He is a diabetic for the last 25 years - he has insulin daily and his diabetes levels are almost under control
3. He has BP too
4. He had mild chest discomfort last week and on the advice of doc, we took ecg, echo & treadmill
5. Doctor informed ECG & Echo are normal (in fact, he commented stating that my dad's heard is really good) and there were few blockage symptoms only through treadmill and hence he suggested Angiogram.
6. After taking Angiogram, as mentioned earlier, he advised for a bye pass.

Bye pass surgery is the last option I want to do for my dad and hence wanted to check if angioplasty is a good alternative considering all the above. Pls help.

Also, if possible, can you pls let me know the basic advantages/dis-advantages between bye pass surgery and angioplasty?

Thanks.

Regards, XXXXXXX

Answered by Dr. Priyank Mody (10 hours later)

Brief Answer:
By all my knowledge angioplasty is a viable option, do take second opinion

Detailed Answer:
Hello ,I did go through all your reports. As you had said all the parameters except the block are normal and hence in that context we are on a safe mode and can take a balanced decision about an elective procedure. Also as there is no heart attack, so post procedure life would be as good as normal.
Now about bypass and angioplasty,
Bypass is an open heart surgery with all associated problem s for a surgery, however your father is fit to undergo a bypass without any additional risk.
For angioplasty as I have theoretically the reason blockage rate is 1-2% higher in diabetics as compactor bypass, however as I said skills matter here and a good cardiologist would be able to achieve similar or even better results (with new drug eluding stents) .
Even XXXXXXX college of cardiology, and European union , recommended angioplasty as in the case you have described
Now on practical front when you use more than one stent your cost increases, which however is individual according to the hospital and doctor you select.
So why angioplasty? Because all other arteries Arr completely free of disease and so post angioplasty we would have a completely clean heart, saving bypass for a later date after 10-12 years, if needed
So by all means it would be a a personal choice whether it is angioplasty or bypass. However if you decide for angioplasty chose a good center and a doctor skilled in bifurcation lesion.
Also good control of diabetes (high in report sent) and other risk factors are important.
Lastly it's not that I am a cardiologist so I would be biased for angioplasty, but a second opinion from a XXXXXXX cardiologist would be helpful as ultimately it's the live CD which helps to make sure how the lesion is and what should be done for treatment.
On the last possibility, because both lesion are just borderline so medical management is still an option if FDG scan/ thallium scan is normal.
Regards Dr Priyank Mody

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Priyank Mody (20 hours later)

Thanks a lot Doctor. Your detailed reply did helped a lot.
As suggested by you, am taking second opinion of a XXXXXXX cardiologist in XXXXXXX

Regards, XXXXXXX

Answered by Dr. Priyank Mody (4 hours later)

Brief Answer:
Happy I could help :)

Detailed Answer:
Happy I could help ,
The only reason I said for a cardiologist there was saying he can see the angiogram CD, whether the ostium of lad is involved, because in the report it is not mentioned and if not angioplasty can be done with ease and good results.
However because I haven't seen the film I wouldn't be able to recommend you with surety.
I would myself be in XXXXXXX in the first week next month for any further assistance.
Regards Dr. Priyank Mody, Lilavati Hospital, XXXXXXX
You can contact me through HCM Http://doctor.healthcaremagic.com/doctors/dr-priyank-mody/70273.
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Above answer was peer-reviewed by : Dr. Raju A.T