LAD 90 % stenosis, which is preferred ? - fs3

[ArchivalUser]

preferred procedure for 90 % stenosis of lad
stent / cabg

[ArchivalUser]

cabg is best

[ArchivalUser]

thanks nimish
i guess kind of expected u to answer.
i know if it involves LAD its cabg, but some books say stent can be done too ? what do u say
guess cabg is best due to no restenosis which is possible with stent

[ArchivalUser]

any cad......
svd,dvd,tvd, left main or all vessel....cabg is always best
cabg is prefgfred in tvd, lt main, dvd with diabetes....

[ArchivalUser]

this is news to me.... i thought only triple vessel disease or left main we go for cabg.

i would have gone for pci and stent in this

[ArchivalUser]

The 2004 ACC/AHA CABG guidelines state CABG is the preferred treatment for:[12]

* Disease of the left main coronary artery (LMCA).
* Disease of all three coronary vessels (LAD, LCX and RCA).
* Diffuse disease not amenable to treatment with a PCI.

The 2005 ACC/AHA guidelines further state: CABG is the likely the preferred treatment with other high-risk patients such as those with severe ventricular dysfunction (i.e. low ejection fraction), or diabetes mellitus.[12]

[ArchivalUser]

i agree if its tvd or svd involving lad or in diabetis - cabg
but did u say svd in any artery ?
if it involves left circumflex alone or RCA do we do cabg ?
plz clarify the reference
thanks

[ArchivalUser]

For any mentioned case above like left main vessel or three vessel blockage or diabetes with two vessel blockage or pci is contraindicated ----best possible treatment - CABG
anything else---pci is the first line of therapy

[ArchivalUser]

duration also if it is greater than 12 hrs after a STEMI----cabg prefferred, less than 12 hrs---fibriolysis-----but if there's a pci option available go for pci as it decreses mortality much mire than fibrinolysis...

[ArchivalUser]

Just my 2 cents:

We also need to think about 90% +LAD. 90 % is a very diffuse disease not amenable to PCI IMHO