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 !
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