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Is PCI or bypass better for a 52-year-old male's LAD block?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hi doctor,

My father-in-law is 52 years old, and he is not feeling well for the last few months. The doctor recommended an angiogram. We just did an angiogram and got the results. Now we want to know if we should insert a stent or bypass it, or if it is curable with medicine. If surgery is needed, can we wait two weeks? Or we should get it done as soon as possible.

The report says,

  1. Vascular Access: Right radial artery.
  2. Drugs Used: Amidol 370 mg.
  3. Catheter Used: TIG 5Fr catheter.
  4. Procedure-related: Uncomplicated.

Comments:

  1. LM: Free of disease
  2. LAD: There is a 100% occluded in mid-segment. Filling retrograde collaterals from the right side.
  3. LCX: Non-dominant vessel and free of any significant disease.
  4. RCA: Dominant vessel free of any significant disease.

Comments: SVD.

Recommendation: PCI to LAD.

Please help.

Thank you.

Answered by Dr. Muzaffer Bahcivan

Hi,

Welcome to icliniq.com.

First of all, I wish your father a speedy recovery.

I examined your patient's history and all tests in detail. Since I could not watch your father's moving coronary angiography images (attachment removed to protect the patient's identity), I cannot say whether coronary vessels will be suitable for CABG (coronary artery bypass graft) or not. However, your father has only one vessel disease, and this vessel is totally occluded. That means there is no urgent need for bypass or interventional procedures.

My opinion is that you should try PCI (percutaneous coronary intervention) first. If it is not successful, then bypass surgery is needed. All these procedures can be done electively.

I hope this helps.

Thank you.

Patient's Query

Hi doctor,

Thank you so much for your response.

We are not sure what to do as my father is stable now. We got the moving coronary angiography images, please watch them. I hope it will provide you with a clear view.

Please guide us on what we should do next.

  1. Should we go for surgery, and if so, how soon?
  2. Also, we do not want to do a bypass. Is it a realistic thought?

Thanks.

Answered by Dr. Muzaffer Bahcivan

Hi,

Welcome back to icliniq.com.

I have watched your father's angiogram. I did not change my previous recommendations. My opinion is that you should try PCI (percutaneous coronary intervention) first. If it is not successful, then bypass surgery is needed. All these procedures can be done electively.

I hope this helps.

Thank you.

Patient's Query

Hi doctor,

Thank you for the reply,

  1. We will try PCI first. Also, is placing a stent in the heart an option for this situation?
  2. Can we wait two weeks to start the treatment?

Thanks.

Answered by Dr. Muzaffer Bahcivan

Hi,

Welcome back to icliniq.com.

PCI mostly means a balloon with a stent. Because the LAD (left anterior descending artery) is totally occluded, there is no emergency situation. You can wait two weeks or more for intervention.

I hope this helps.

Thank you.

Patient's Query

Hi doctor,

Thank you for the reply,

So we have nothing to worry about. The LAD is totally occluded, but not the other parts.

  1. So, there is no emergency situation. Is that good?
  2. Also, if PCI does not work, is there any alternative to bypass surgery?

We really want to avoid bypass.

Please help.

Thank you.

Answered by Dr. Muzaffer Bahcivan

Hi,

Welcome back to icliniq.com.

Yes. If PCI does not work, then a bypass is necessary. Bypass can be minimally invasive with 99 percent success.

I hope this helps.

Thank you.

Answered byDr. Muzaffer Bahcivan

Medically reviewed byiCliniq medical review team

Published At January 13, 2023
Reviewed AtAugust 1, 2025

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Muzaffer Bahcivan
Dr. Muzaffer Bahcivan

Cardiothoracic Surgery

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