This is an RCA of a patient who had chronic stable angina , class 2 with moderate anti anginal medication.
What shall we do ?
- The RCA needs multiple stenting
- Multiple plain balloon angioplasty
- CABG to PDA
- No intervention ?
- It depends upon status of LAD and LCX
The correct response would be 5
Without knowing the status LAD and LCX . . . RCA should not be touched . Further, the concept of tackling the coronary artery by itself is fundamentally wrong ! We are supposed to tackle patient’s symptom , reduce future risk of events and not merely their coronary artey !
His LAD and LCX was near normal. In the weekly cath meet PCI to mid RCA covering the critical segment was strongly debated but lost a close race .
The final decision was to allow the patient to continue intensified medical management (Statin 80mg /Metoprolol 100mg ) . He is comfortable with that .
Medical management in a tight single vessel disease can never be digested by any Interventional cardiologist whatever may be the guidelines !
Final message
Do not decide PCI on the basis of how ugly a coronary artery looks , rather spend some time on true symptomatology , optimise baseline therapy and re assess risk profile
One learned dictum is , do not meddle a RCA , however severe the lesion may be if LAD and LCX are fine.*
*This rule is not applicable in ACS
Dr.S.Venkatesan MD 
Right now I am a student yet, but I like the concept of this article very much. I like the idea of focusing on a man’s symptoms rather than starting with the intervention on RCA just because angiogram is not normal. Checking the LAD and LCX status can save money and time and after all, can reduce patient’s stress because of intervention.
Amazing website. I agree with you 100%. I am an interventional cardiology fellow in USA. Here, it would be hard to protect this RCA from a stent 🙂
BTW, I am a graduate of Madras Medical College, and I believe that it is the wisdom of professors in India practicing ‘real-world’ medicine (not ‘textbook medicine’ or ‘real-USA medicine’) that is unparalleled and needs to be disseminated through media such as this blog. Thanks!