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Dizziness, occasional chest pain. CT Angiography done. What does the result indicate, does it require stent insertion?

Can you please advise if the patient with following CT angiography results require insertion of stent? Age: 63 years Sex: Male Calcium Score: 251.8 (Agatson) LMS: 65.4, LAD 104.1, LCx 41.8, RCA: 40.6, TOTAL 251.9 LMS: Normal LAD: Mixed plaque. 60%-70% disease in proximal course and mid course LCx: Mixed plaque. 60%-70% disease in proximal course and mid course Tri branch: Mild disease in proximal course RCA: Dominant. Spotty calcification . Unobstructive. Diagnosis: DVCAD The patient has normal cholesterol and sugar level. But for the last 4 - 6 weeks he has been feeling dizzy with occasional chest pains near the heart. Regards, Awais Mehmood
Asked On : Wed, 29 Aug 2012
Answers:  2 Views:  74
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Cardiologist 's  Response
Dear Mr Mehmood,
Thanks for writing. I am qualified and certified cardiologist.I read your question with diligence. Normally, we reserve revascularisation by stent implantation or coronary artery by pass grafting for lesions more than 70% occlusion, unless a) spasm is additional contributory factor b) it is a situation of acute coronary syndrome. Reading your CT angiography report it appears your arteries are moderately calidified and lesion is diffuse. Real situation is often revealed with 100% certainty with routine coronary angiogram combined with what symptoms patient is having with maximum medical therapy. With the available data I would definitely try maximum medical therapy rather than intervention of LAD with coronary angioplasty with stent implantation first. Leaving option of intervening if so required. Good Luck.
With Best Wishes.
Dr Anil Grover
MBBS, MD (Medicine) DM(Cardiology)

Answered: Thu, 30 Aug 2012
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General & Family Physician Dr. Kulbir Singh's  Response
Hello and thanks for the query
Usually we needs stent implantation when their is more than 70% lesion in artery. You have 60-70% lesions in two arteries. But more importantly you have symptoms like chest pain, dizziness etc. So if both are to be taken into account you surely be need revaculization with PTCA and stent implantation.
Rest the decision is to be taken by your cardiologist by seeing your Angiography and by giving you medication. If your chest pain is frequent and associated with shortness of breath than in my opinion you must go for stent implantation.
Best Wishes
Answered: Thu, 30 Aug 2012
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