PT age around 60 year,,diabetic,, kidney stones,, and now suffering fm heart problems,, above angiography report, plz suggest treatment plan

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After angioplasty we can't stoo ANTIPLATELET e for 1 year specially with DES AND LMCA STENTING. So we should see what's kidney stone size renal dysfunction and wha is angina class. Timing of ptca and treatment of renal stone should be done with proper discussions between patient cardiologist and urologist.so that issue is very important

Dr Tushar as it is ostial LMCA PCI WILL BE PREFered .with newer generation stent PCI is equivalent to surgery. Pt syntax score is low.so here PTCA BETTER IN CLINICAL PRACTICE.had it been LMCA BIFURCATION OR ASSOCIATED MULTIVESSEL DISEASE WITH HIGH SYNTAX SCORE CABG WOULD HAVE BEEN BETTER.

I do agree with guidelines.but they are randomised PT.IN FREEDOM TRIAL MOST PT had MULTIVESSEL CAD so here if u do incomplete REVASCULARISATION with DES CABG BETTER THAN DES.in above scenario only ostial LMCA AND LAD NEED TO BE TACKLED.hence PCI can safely done with less morbidly than CABG.it depends on centre also DR G R KANE IS GOOD OPERATOR SO CAN SAFELY DO PTCA. Had LMCA PLAQUE EXTENDING TO BIFURCATION THEN I WOULD SEND FOR CABG.

as iam working in intensive care ,first work up for kidney stones ,it will problem once u start antiplatelets u can't stop it ,pt needs CABD left main disease as pt diabetic ,age . so please ,I have seen pt who had done kissing plasty ,2 day back post thrombolysis (difficult plasty) had kidney stone ,started heamaturia due to stone ,pt was expired .2- 3 cases

This pt will need 1 stent to ostill LMCA and another stent to proximal LAD.life style modification dual ANTIPLATELET statin BetBlocker.ostial AND SHAFT LMCA DISEASE IS FEASIBLE TO TREAT BY STENT .

angioplasty should be done first. after recovery of month or more laser surgery for kidney stone can be done. control of bloody sugar must.

So here no doubt PTCA WIth stent to LMCA AND Additional stent to LAD

As LMCA IS BIG ARTERY Chance of re stenosis will be less

My choice here PTCA

pt need to undergo cabg as pt is diabetic and has lmca...so pci will have high restenosis rates ..so for complete revascularisation ,cabg wud be better

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