Q. My dad has undergone angio for CAD. How many stents are needed to be placed?

Answered by
Dr. Ilir Sharka
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Mar 09, 2020 and last reviewed on: Mar 14, 2020

Hi doctor,

My dad recently had chest pain, we took EKG and echo and it turned out as though he had a slight abnormality. We got the angio done the reports shows:

LAD: Type III LAD has 50% proximal stenosis. Mid and distal has a mild diffuse disease.

RI: Has 80% proximal stenosis.

LCX: Non-dominant LCX is normal.

RCA: Dominant RCA has 80% proximal stenosis. Mid segment has diffuse disease. Distal segment has tandem 80% or 90% stenosis. PDA has 60% mild segment stenosis.

Diagnosis: Coronary artery disease. Right dominant system. Severe RCA disease.

Recommendation: PCI to RCA.

I would like to know how many stents are needed on the right and what changes need to be done in the lifestyle.

His bad cholesterol: 60, good cholesterol: 33, normal BP with vitamin B12 and D deficiency.

Dr. Ilir Sharka

Cardiology
#

Hello,

Welcome to icliniq.com.

I passed carefully through your dad's medical history and tests and would like to explain that it is necessary to perform percutaneous coronary angioplasty followed by stents implantations in the right coronary artery in several segments (80% proximal stenosis, but also in the distal segment where there are consecutive stenosis 80%-90%).

So, at least two to three stents will be most likely necessary to properly treat hist RCA (right coronary artery). On the other side, life-style modification would be necessary to stop the progression of atherosclerosis in several parts of the coronary arteries tree.

First, vitamin B12 and vitamin D deficiencies should be properly corrected. Then a balanced diet with low saturated fat (animal fat) and rich in green vegetables should be encouraged. He should refrain from every smoking contact and periodically check his blood lipid profile and blood pressure values. After stenting special antithrombotic drugs are prescribed as well.

I hope this helps.


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Thank you doctor,

What does RI OR RL mean in the report? Two stents for 80% of RCA and 80 to 90 in the distal segment? So clearing up this might start putting pressure on PDA, so they might have to put a stent there too. Is it necessary that all the angio procedures will need a stent to be placed? How long is the recovery period and how long should we check for postop? Can he travel comfortably after this procedure say after three months? He does not have blood pressure. Does the blood thinners then cause more damage? There is no smoking or drinking involved.

Dr. Ilir Sharka

Cardiology
#

Hello,

Welcome back to icliniq.com.

I would explain that RI stays for ramus intermedius a branch between LAD (left anterior descending artery) and LCX (left circumflex artery), in certain individuals it has a great caliper and in such case, if there are significant stenoses they need to be treated too (by means of angioplasty and stent implantation).

PDA (patent ductus arteriosus) is another secondary branch (it stays for descending posterior artery), for stenoses around 50% the strategy is variable. It may be treated conservatively with drugs and followed up to see for possible progression.

In general, after hospital discharge, the patient may undertake the daily activity (as far as no myocardial infarction has been present). So, he can travel safely after three months.

Regarding blood thinners, they are necessary and should be taken regularly (double therapy) at least during the first year after the procedure, as they protect from stent thrombosis and other vascular complications. They have nothing to do with hypertension. And you should not worry about this issue. The patient just needs to follow a regular lifestyle and avoid the above-mentioned risk factors.

I hope this helps.


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