Brief Answer:
yes every blockage more then 75% requires intervention

Detailed Answer:
Hi
dear
Firstly thanks for choosing HCM for your query

There are various types of stents available these days ,every stent have some pros and cons associated with it.
some times age of the patient,site of blockage plays a critcal role in deciding the type of stent to be usedwhile enclosing the CD and printed reports of your angiogram.

There are currently four types of stents available:

Dual Therapy Stent (DTS)
Bioresorbable Vascular Scaffold (BVS)
Drug Eluting Stent (DES)
Bare Metal Stent (BMS)

I am going to give you a brief idea about each category of stent ,once i recieve your angiogram reports and your angiogram video i will suggest you which out of four types would suit you the BEST.


1)Dual Therapy Stent-
Latest type of coronary stent,designed to reduce the likelihood of the re-narrowing of the artery ,clot formation and restenosis.

Drug-eluting stents also have been shown to be superior to bare-metal stents in reducing short-term complications of stenting like restenosis and having repeat procedure.
It also helps in healing process of damaged coronary arteries.
The stent surface facing the artery wall contains a drug that is released to help stop the artery blocking again without the worry of swelling or an inflammatory response. The drug is delivered from a bioresorbable polymer that will degrade over time.
The side of the stent which faces blood flow is coated with antibodies, which promote natural healing and helps the healthy artery function properly.
Various trails have been done on these latest stents AND A CLEAR SUPERIORITY OF THEM ARE ESTABILISHED OVER BARE METAL STENT,its the stent of choice for most of the cardiologist in XXXXXXX (personally my favourite ,long term outcomes are great with less then 1% complications)

2)Bioresorbable Vascular Scaffold-
The Bio-Vascular Scaffold (BVS) is a drug eluting stent on a dissolvable type of scaffold platform which can be absorbed by the body over time.

Like some of the currently available Drug Eluting Stents (DES), BVS is coated with a drug released from a polymer that disappears over time to reduce the likelihood of the artery re-narrowing (restenosis). The scaffold itself is absorbed overtime. Unlike with the DTS, there is no active element to promote artery healing.The advantage of this type of stent is that antiplatelets can be discontinued after few years post angioplasty .However long term trails results are still awaited for these stents.
The BVS stent was tested by Abbott in the ABSORB trial( name of stent is ABSORB), in which 30 patients received stent implants. In the study, 80% of the
drug was released by the 30-day follow up ,After one year follow up, however,
there was no stent thrombosis and only one patient experienced a heart attack. Though a very good stent yet long term trials are still awaited.

Drug Eluting Stent -Drug Eluting Stents (DES) are coated with medication that is released (eluted) to help prevent the growth of scar tissue in the artery lining. This helps the artery remain smooth and open, ensuring good blood flow and reduces the chances of the artery re-narrowing or restenosis. However, it also leads to a higher chance of blood clots (stent thrombosis).Due to a relatively slower healing process, patients implanted with DES must strictly follow their doctor's recommendation on drug therapy (DAPT) to help reduce risk of stent thrombosis.LIFE long antiplatelet therapy is to be used after these stents to prevent re thrombosis.

Bare Metal Stent - they are not preferred these days

this was a brief introduction to the latest stents used these days,however which stent will be best for you depends on you age,location of blockages,arteries involved .
Kindly attach the detailed copy of angiogram reports and the video,please do mention from which country you are .
As per you query regarding my views any blockage in coronary artery more then 75% is to be treated immediately with intervention(stenting or cabg) as per the case.

thank you
PLEASE LET ME KNOW IF YOU WANT MORE DETAILS ABOUT THESE STENTS OR IF YOU WANT TO READ THE TRIALS DONE ON PATIENTS .I will be happy to help you.

Dr Rishu Saxena
Resident Cardiologist XXXXXXX

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Brief Answer:
Email id

Detailed Answer:
Hi ,
My email id is YYYY@YYYY
send the video as well as the printed reports of angiography which doctor gave you,because he would have mentioned your left ventricular ejection fraction in that, so printed copy have to be attached .
if a 2d echo has been done kindly attach a copy of that too.
please do answer the following questions

why was angiography done?
are you symptomatic i.e chest pain or breathlessness on walking or climbing upstairs
were you a smoker or alcholic
thank you
Dr Rishu Saxena

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Brief Answer:
ABSORB stent should be deployed as early as possible in lad

Detailed Answer:
Hi
Have gone through all your reports
There are two blockages in Left anterior descending artery ,its a very important artery as left ventricle and interventricular septum of the heart is supplied by it(in easy words LAD supplies 70% of heart), There are two significant lesion( BLOCKAGES ) IN MID LAD ,LAD supplies the left ventricle of heart which is responsible for pumping blood through out a body, a blockage in LAD should always be taken seriously as a compromised blood supply can lead to extensive anterior wall M.I.
In your case the lesion is causing critical narrowing of LAD ,WHICH SHOULD be stented immediately.There is critical narrowing of the artery in the middle part of LAD.A complete blockage can result in a massive anterior wall myocardial infarction ;hence you should get it stented as early as possible,dyskinesia in interventricular septum as depicted by 2d echo is also because of improper blood supply to septum due to blockages.

As age of the patient is 73 , I would suggest you to go for Bioresorbable Vascular Scaffold-named ABSORB (by abott labs),it would be a bit costly but the main advantage is that dual antiplatelet (blood thinner ) therapy is required only for 1 year after stenting.
Anti platelets are blood thinner and in elderly can pose risk of bleeding, and stroke ,With ABSORB stents ,these antiplatelet blood thinner would be stopped after a year and hence risk of bleeding and haemorragic stroke is significantly decreased.

I will mention here few trials name

In the CURE trial significant increase in major (3.7 versus 2.7 percent), minor (5.1 versus 2.4 percent), and gastrointestinal bleeding (1.3 versus 0.7 percent),was seen in patient on drug eluting stent(XIENCE XPIDITON) vs Bioresorbable Vascular Scaffold stents ( like ABSORB).


So my suggestion is to go for ABSORB stent as in the long term it significantly decreases the risks posed by life long ant iplatelet therapy.

thank you
If you wish to ask any other query feel free to ask.
Wish you a safe recovery .
In case you have other queries you are free to ask , if you like the answers ,please do leave a review
Thank you
Dr Rishu Saxena
Cardiologist XXXXXXX hospital XXXXXXX
New XXXXXXX

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