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Diagnosed with cholesterol. Angioplasty done. What are the risks?

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Answered by

Practicing since : 1981
Answered : 922 Questions
Hi Doctor.
I am a 63 year old male with a cholesterol readind before Angioplasty of 7.1 and elevated blood pressure. My mother died at age 43 due to a malfunctioning valve. I had angioplasty 5 days ago and this is the report:

LCx lesion was crossed,
Predilation with 2.5 mm balloon,
Stented with 2.75 x 26mm Resolute Integrity DES,
Post dilation with 3 x 15mm NCballoon up to 16 atm,
Excellent result.

I am however worried as to why doctors did not act on the following findings:

LM: Normal,
LAD: 60% stenosis mid segment. Significant 70-80% stenosis ostial diagonal disease.
LCx: Tight 90% stenosis mid segment with ulcerated plaque.
RCA: Dominant artery. Diffuse minor luminal irregularities.
LV gram: Normal systolic function.

Should cardiologists have repaired the problem? What are the risks?

Thank you
Posted Sun, 14 Oct 2012 in Hypertension and Heart Disease
Answered by Dr. Anil Grover 2 hours later
Thanks for writing in.
I am a qualified and certified cardiologist. I read your question with diligence.
LCx 90% mid portion ulcerated (if you are referring where angioplasty and stent implantation was done) then it could not be tackled better than what was done.

I hope your question is about 60% lesion of LAD. Standard guidelines are to dilate the lesions which are above 70% and / or the culprit lesions for acute coronary syndrome (source for unstable angina, EKG changes or myocardial ischemia). Your cardiologist would have taken a decision based on that for stent implantation has finite though minimal complications and mid to long term risk again minimal, of total occlusion as a result of Stent Thrombosis.
Moreover, it has been seen that such lesions do show at times regression at least these become stable on drug therapy which you must have been started or optimized. Therefore, while technically it would have been simpler than then the LCx lesion, it was a prudent decision to leave LAD and I entirely agree with your treating cardiologist(s). If you have any followup question, I will be most happy to answer. Good Luck.

With best wishes.
Dr Anil Grover,
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW

Above answer was peer-reviewed by
Follow-up: Diagnosed with cholesterol. Angioplasty done. What are the risks? 20 hours later
Thank you Doctor for your prompt reply.

I understand the explanation of the LAD 60% stenosis, however can you please explain what is meant by: Significant 70-80% stenosis ostial diagonal disease.
I was of the impression I have a 70-80% stenosis of the LAD or are they saying that it is 60% and had it been 70-80% than it would have been classed as significant and action would have been taken.

What are the risks with these lesions and what can be done to prevent them?
Answered by Dr. Anil Grover 1 hour later
Thanks for writing back.
As per the report you sent LAD is 60% lesion and explanation for not interfering with it is logical. Your question about 80-90% of ostial lesion of diagonal ( you have not not mentioned it is diagnal 1 called D1 or 2 or 3 called accordingly D2 D3) there is more to name. Reasons for not interfering with diagonal ostial lesions are:
1. Lesion is right at the origin so dilatating it may in the judgement of operator fraught with danger of injuring LAD (technically dissection is the injury and dilatation is nothing but controlled dissection of vessel). That would have meant additional risk and stent implantation in LAD. Others, I am guessing for I have not seen the angiograph (ask WWW.WWWW.WW customer help if they can upload some images.

2. The Diagonal vessel is equal to or smaller than diameter of 2.5 mm with small area of blood supply of the heart. The benefit achieved by dilatation and implanting a stent, in the judgement of operator, was not significant enough when comparing to risk it involved.

3. The diagonal may be arising from the lesion of LAD that would have meant implantation of two stents mandatory. And the risk benefit ratio would have favored not doing this procedure.

A thing must be understood is that cosmetically good looking angioplasty is not necessarily the best procedure for which vessel to dilate and which vessel is to leave is taken in good faith (taking many things into considerations). As I am not privy to thought process of your esteemed treating team, so I have no reason to distrust them. Whereas, you as a patient has every right to ask questions. If there is more I will be happy to answer. Regards
Best Wishes.

Dr Anil Grover
Above answer was peer-reviewed by
Follow-up: Diagnosed with cholesterol. Angioplasty done. What are the risks? 28 minutes later
Thanks for the reply.
Is the LAD 60% stenosis a different problem than the Significant 70-80% stenosis ostial diagonal disease.

What are the risks with these lesions and what can be done the risks?

Regards XXXXXX
Answered by Dr. Anil Grover 52 minutes later
Thanks for writing back.

Heart is supplied by three arteries RCA (Mainly supply, right ventricle part of left ventricle base and part of inter-ventricular septum). Arises separately. Left Anterior Descending and Left Cicumlflex LAD and LCx arise from Left Main artery. Supply major part of left ventricle. LCx give rises to branches called Obtuse Marginal (OM1-4 or more) and continues as posterior descending artery in most. LAD gives rise to 4-5 septal branches S1 to S4 and similar number of Diagonal Branches D1- D2 which take blood from LAD to major part of left ventricle. Therefore, main arteries are most important RCA, LCx and LAD where as branches are less. This is further dependent on diameter and size of each branch. In stent implantation all these factors weigh in.

The drugs which has been prescribed to you will not only keep the stent patent will also prevent other minor lesion in major artery or major lesion in minor arteries from progressing. Drugs along with diet and exercise will take care of the rest. That seems to the general plan in you. We say in India, Hurry Worry and Curry are the major factors. Thankfully curry is not a major problem in West whereas Hurry and worry is. Stay away from these two too. That is prevention. Good Luck.

Best Wishes.

Dr Anil Grover
Above answer was peer-reviewed by
Follow-up: Diagnosed with cholesterol. Angioplasty done. What are the risks? 27 hours later
Since the insertion of the Stent, I am still experiencing continuous slight pain in my chest. It feels like a combination of compression, tightness, heaviness and burning.

Is this common or should I be worried?

Kind regards XXXXXX
Answered by Dr. Anil Grover 1 hour later
Hi There,

You must have been advised follow up with the group of cardiologists who did the stent implantation, it is sort of mandatory for first 6 months. Personally, I do not think you have stent blockade otherwise those would have been your first and foremost symptoms. I urge you to fix an early appointment with the doctor. Without seeing you in person it is not possible for me to comment with certainty. However, it is not uncommon symptom.

Dr Anil Grover
Above answer was peer-reviewed by
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