Coronary atherosclerosis can strike an artery with variety of lesions.It can be any of the following.
- Focal
- Ostial
- Eccentric
- Discrete
- Diffuse
- Tandem
- Ectatic
- Multiple
Rarely a coronary artery is blessed with all of the above characters , added with homo and hetero collaterals . . . resulting in Atherosclerotic chaos !
What is chaos ?
Note one such vessel inflicted with chaos lesions
How to you report the above angiogram ? What can be done ?
We do not treat an angiogram. We need to know the clinical background. (This is a 50 year old man with chronic stable angina ) He also had a lesion in LAD and was advised CABG with grafts to LAD and PDA.
Is PCI possible in such a vessel ?
Most would agree , it is a crime to think about PCI in the above vessel. Still , few hard-core interventional cardiologists may vouch for success in this vessel !
Is there any alternative management other than CABG in this vessel ?
Leaving it alone can be an intelligent strategy . (If LAD is normal it may be the best possible management) . But , CABG will remain a default choice. But , when a person is having such a rampant atherosclerosis he is at high risk for pre- mature graft disease as well. Hence , intensive medical management will be the key in such patients irrespective of any revascularization procedure.
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