Brief Answer:
I would recommend as follows:

Detailed Answer:
Hello!

Welcome and thank you for asking on HCM!

Regarding your concern, I would like to explain that after reviewing all your uploaded angiography reports, seems that your relative has a clear evidence of atherosclerotic coronary artery disease.

Obviously, all the three main coronary arteries are affected by premature atherosclerotic process, but to a different degree.

Actually, the most important coronary lesion, which seems to be responsible for the patient clinical symptomatology and may seriously lead to a dangerous acute coronary syndrome, is that 90% coronary stenotic lesion at the middle LAD artery level.

It is considered a clinically significant lesion and requires a prompt revascularization procedure. The most appropriate approach (when performed by experienced hands) would be achieved by a per-cutaneous coronary angioplasty with stent (a drug-eluting stent) implantation at the level of stenosis, followed by a double antiagregant therapy regimen (according to current medical guidelines).

The other two coronary arteries (RCA and LCX) and their secondary branches are also affected by atherosclerosis, but to a lesser degree. Actually, these lesions do not reach clinical significance and are unimportant. In general, they could not cause myocardial ischemia, so no current revascularization procedures are necessary.

But, from the other hand, these apparently non-significant coronary lesions may progress to more severe atherosclerotic plaques, being able to induce myocardial ischemia and threatening consequences at a near future.

That's why, a vigorous preventive strategy should be applied to prevent a further progression of atherosclerotic process, thus impeding those plaques from becoming problematic.

Your relative should avoid/treat potential coronary risk factors, such as dyslipidemia (through a healthy [diet poor in saturated fat and rich in veg fibers] and underlying drugs such as statins), possible hypertension (through controlling body weight and antihypertensive drugs prescription), managing possible glucose intolerance or diabetes (through diet, physical activity, or even appropriate medications), avoiding close smoking contacts, and engaging in more intensive daily physical activity (recommended at least 4 km walking/day).

So, to conclude, I would advise (as his doctor has recommended too), that the most immediate medical intervention would be a coronary revascularization procedure with stent (DES) implantation on that 90% LAD stenotic lesion followed by a serious medical preventive strategy.

He should discuss with his attending physician (cardiologist) about the above mentioned issues.

Hope to have been helpful to you!

Feel free to ask me whenever you need! Greetings! Dr. Iliri

---

Brief Answer:
Coronary revascularization remains the most optimal solution.

Detailed Answer:

Hello again!

Coming to this point, I would explain that coronary revascularization (through angioplasty and stent implantation) seems to be the most appropriate solution to the problem, as I explained above.

Sure, cardiac drugs may help to relieve symptoms, but they are not a definitive and reliable solution.

A beta-blocker (like metoprolol, atenolol, bisoprolol, etc), an antiagregant like aspirin, a statin (like atorvastatin, etc), any nitrates (isosorbite dinitrate, etc), ACEI (lisinopril, ramipril, etc) or ARB (olmesartan, irbesartan, etc), could be important components of his daily therapy (if no specific contraindications exist).

You need to discuss with his doctor about the best combination (according to his specific medical conditions).

Best wishes,

Dr. Iliri

---