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



Dr.santosh FREEDOM trial ...cabg was superior to DES for mortality......also acc aha guidelines 2012 recoomends cabg as class I and pci as class IIa dat to with syntax score less than 22

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

CABG with control of DM&renal problem

CABG is the best choice here..

double conduit CABG

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 above scenario only ostial LMCA AND LAD NEED TO BE TACKLED.hence PCI can safely done with less morbidly than 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

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 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 here PTCA BETTER IN CLINICAL PRACTICE.had it been LMCA BIFURCATION OR ASSOCIATED MULTIVESSEL DISEASE WITH HIGH SYNTAX SCORE CABG WOULD HAVE BEEN BETTER.

for kidney stone and vit. d stone means in our blood there are some substances that have tendency to clots and form stone, that maximum calcium related, and in our country there are maximum 96 or 98% vit. d deficiency, when if we give

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