Hello. Thank you for your question and welcome to HCM. I understand your concern. I do not know to which artery was the invasive cardiologist referring to. My opinion also would be to proceed immediately to percutaneous transluminal coronary angioplasty (PTCA) with stent placement to the LCx OM2 branch, if an artery with good calibre. As for the left anterior descendent artery (LAD), it would be worth trying to open a chronic total occlusion, because, since it is chronic, it probably has collateral routes of supplying that part of heart muscle with blood (oxygen and important nutrients). No matter what are the levels of cholesterol, the atherosclerotic plaque within a coronary artery does not acutely refer to the cholesterol levels, per se. It is a long process which starts in early childhood, and there are factors which promote it or hold it and make it progress slower. After the stent placement, proper medical treatment should be started to fight these cholesterol levels, with the aim of bringing it lower than 220 mg/dL. I would recommend a hydroxy methyl glutaryl coenzyme A reductase (HMG-CoA) inhibitor - statin - for this purpose, because they act by inhibiting the action of one of the most important enzymes in the cholester biosynthesis. I hope I was helpful. Kind regards, Dr. Meriton