Coronary atherosclerosis can strike an artery with variety of lesions.It can be any of the following.
- Focal
- Ostial
- Eccentric
- Discrete
- Diffuse
- Tandem
- Ectatic
- Multiple
Rarely a coronary artery is blessed with all of the above characters , added with homo and hetero collaterals . . . resulting in Atherosclerotic chaos !
What is chaos ?
Note one such vessel inflicted with chaos lesions
How to you report the above angiogram ? What can be done ?
We do not treat an angiogram. We need to know the clinical background. (This is a 50 year old man with chronic stable angina ) He also had a lesion in LAD and was advised CABG with grafts to LAD and PDA.
Is PCI possible in such a vessel ?
Most would agree , it is a crime to think about PCI in the above vessel. Still , few hard-core interventional cardiologists may vouch for success in this vessel !
Is there any alternative management other than CABG in this vessel ?
Leaving it alone can be an intelligent strategy . (If LAD is normal it may be the best possible management) . But , CABG will remain a default choice. But , when a person is having such a rampant atherosclerosis he is at high risk for pre- mature graft disease as well. Hence , intensive medical management will be the key in such patients irrespective of any revascularization procedure.
Coronary atherosclerosis can strike an artery with variety of lesions.It can be any of the following.
What is chaos ?
Note one such vessel inflicted with chaos lesions
How to you report the above angiogram ? What can be done ?
We do not treat an angiogram. We need to know the clinical background. (This is a 50 year old man with chronic stable angina ) He also had a lesion in LAD and was advised CABG with grafts to LAD and PDA.
Is PCI possible in such a vessel ?
Most would agree , it is a crime to think about PCI in the above vessel. Still , few hard-core interventional cardiologists may vouch for success in this vessel !
Is there any alternative management other than CABG in this vessel ?
Leaving it alone can be an intelligent strategy . (If LAD is normal it may be the best possible management) . But , CABG will remain a default choice. But , when a person is having such a rampant atherosclerosis he is at high risk for pre- mature graft disease as well. Hence , intensive medical management will be the key in such patients irrespective of any revascularization procedure.