Talk to Cardiologist on Arteries Block Any Other Option Than Bypass
Asking For Mother, Female 68, hassan abdal
Dear Doctors,
My mother, aged 68, has been diagnosed with Coronary Artery Disease. We consulted doctors at RIC and AFIC, who recommended a bypass surgery. However, our family, and particularly my mother, is very apprehensive about this procedure. She has expressed a strong preference to rely solely on medications, stating that she is willing to accept the risks associated with this approach.
*Left Main Stem:* Distal tempering with critical disease Bifurcating
*Left Anterior Descending Artery:* Moderate ostial critical disease in proximal to mid course (calcific vessel)
*Left Circumflex Artery:* Non Dominant in proximal course critical ostioproximal disease in OM branch
*Left Corony Artery:* Dominant critical disease in proximally calcific vessel
*Her medical profile includes the following:*
She is diabetic, with an average blood sugar level of 350.
She has been advised that her kidney condition is not good.
She is also overweight, which further complicates her condition.
Dr. Kifayat H Qazalbash - Cardiologist
MBBS, FCPS (Internal Medicine), FCPS (Cardiology), Fellow Cardiac Electrophysiology (Ireland) | Karachi
Dear NOK,
I can see your mum has multiple co-morbs, and that she is Diabetic. She is also obese as per your information. And the Angiographic Report clearly mentioned that she has Left Main plus Extensensive Critical to Moderate Coronary Artery Disease. I could not see comment on RCA which must be dominant vessel.
I would suggest to opt. for CABG. That is first line Indication even according to the guidelines. But also she is Diabetic and Chronic Kidney Disease. Long term benefits of CABG surpass compare to stenting.
I can confidently say thay with Critical Left Main Disease she wouldn’t survive a single adverse event.
Counsel her, CABG would be the best option even in terms of long term benefit in her case.
Kindest Regards.
Dr. Anees Rajput - Cardiologist
MBBS, Dip. Cardiology | Karachi
She has a three vessel disease so it is better to hv CABG ( Surgery ) of your mother, plus she is having uncontrolled Diabetes and according to you her Kidney condition is not well. so keeping all these things in view and as per her Doctor advise go with Surgery.
Prof. Dr. Anjum Ilahi - Cardiologist
MRCP, FRCP, MBBS, D.Card, Dip. Cardiac Medicine, Dip. Echocardiography, | Islamabad
13 Positive Reviews
Although CABG is the right is the right thing and every other option is inferior. If the surgery is refused then medical therapy needs to be very fine tuned.
Nitrates, betablockers (highly selective), SGLT2 inhibitors, Gli agonists, Ranolazine, dual platelet therapy, statins ,ezitamibe , and treatment of diabetes in optimum doses need to be given.
Dr. Hassan Shabbir Arain - Cardiologist
MBBS, FCPS (Cardiology), MRCP (UK), CHPE(NUMS), FCPS (Interventional Cardiology)(AFIC) , FACP(USA) , Certified National Board Of Echocardiography and Cardiac Imaging (USA) | Islamabad
22 Positive Reviews
Bypass Surgery is superior in her situation, but if she is unwilling then Stenting can be done with suboptimal complete revascularization
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