How many stents are needed for 80 percent RCA stenosis?

Question

Hello doctor,

My dad recently experienced chest pain, so we conducted an EKG and an echocardiogram, which revealed a slight abnormality. We proceeded with an angiogram, and the reports showed the following:

Findings:

LAD (left anterior descending): Type III LAD with 50 percent proximal stenosis. The mid and distal segments have mild diffuse disease.
RI (ramus intermedius): 80 percent proximal stenosis.
LCX (left circumflex): Non-dominant LCX is normal.
RCA (right coronary artery): Dominant RCA with 80 percent proximal stenosis. The mid-segment shows diffuse disease, and the distal segment has tandem stenosis of 80 to 90 percent.
PDA (posterior descending artery): 60 percent stenosis in the mid-segment.

Diagnosis:

Coronary artery disease.
A right dominant coronary system with severe RCA disease.

Recommendation:

Percutaneous coronary intervention (PCI) for the RCA.

Additional details:

His bad cholesterol (LDL): 60 mg/dL
Good cholesterol (HDL): 33 mg/dL
Normal blood pressure.
Diagnosed with vitamin B12 and D deficiencies.

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

I carefully reviewed your dad's medical history and test results, and I would like to explain that it is necessary to perform percutaneous coronary angioplasty followed by stent implantation in the right coronary artery (RCA). Stents will be required in multiple segments, including the area with 80 percent proximal stenosis and the distal segment where there are consecutive stenoses of 80 to 90 percent. Therefore, at least two to three stents will likely be necessary to properly treat his RCA.

In addition, lifestyle modifications will be essential to prevent further progression of atherosclerosis in other parts of the coronary arteries. First, vitamin B12 and vitamin D deficiencies should be addressed and properly corrected. A balanced diet low in saturated fats (such as animal fats) and rich in green vegetables is highly recommended. He should completely avoid smoking or any exposure to tobacco. It is also important to periodically monitor his blood lipid profile and blood pressure to ensure they remain within healthy ranges.

After stenting, your dad will need to take prescribed antithrombotic (blood-thinning) medications to reduce the risk of complications. These measures, combined with the procedure, will help manage his condition and improve his overall cardiovascular health.

I hope this information helps clarify the next steps. Please let me know if you have any additional questions.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

I would like to explain that RI refers to the ramus intermedius, a branch located between the LAD (left anterior descending artery) and the LCX (left circumflex artery). In certain individuals, it has a significant diameter, and if there is substantial stenosis, it may also require treatment, such as angioplasty and stent implantation. PDA refers to the posterior descending artery, another secondary branch. For stenosis of around 50 percent, the treatment strategy can vary. In many cases, it is managed conservatively with medication and monitored over time to assess for any progression.

In general, after hospital discharge, the patient can resume daily activities as long as no myocardial infarction has occurred. Traveling should be safe after three months. Regarding blood thinners, they are essential and must be taken regularly (dual antiplatelet therapy) for at least the first year following the procedure. These medications protect against stent thrombosis and other vascular complications. They are not associated with hypertension, so you do not need to worry about this aspect.

The patient simply needs to maintain a healthy lifestyle and avoid the previously mentioned risk factors.

I hope this explanation helps.

Thank you.