Dr.S.Venkatesan MD

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.