Every Coronary artery disease is not meant for stent or bypass surgery. There are different type of coronary artery diseases in different individuals.we can not apply one criteria to every patient. for example if all three coronary arteries are diseased it doesnot mean that patient require bypass surgery. in such cases many times medical therapy or stent in one most stenosis part of one artery is sufficient.
case 1- a 67 year male was admitted with chest pain with ECG changes, I advised him some blood thinners and injection. his symptoms relieved then i did his angiography. it showed that clot is dissolved hence i put him on medicines.
case 2- 75 year old male with very low body weight with thin bulit with COPD disease was having complaints of chest pain with difficulty in breathing with sweating, his ECG showed Anterior Wall MI. I did his Stenting in his LAD artery. his other vessels were also stenosed but i left them on medicines. 4 year followup, patient is doing well.
case 3- I encountered with 43 year diabetic male with chest pain on exertion with st depression in ecg. angiography showed tripple vessel disease. I thouroghly examined his angiogram and advised him medical therapy while other doctors told him to get bypass surgery done. i advised him to be on medicine only because my observation were that his stenosis were present in distal vessels and caliber was small and his obtuse marginal artery were disease free. hence medicine therapy will be the best. 1 year followup showing that my opinion was right.i am discussing such cases because many of patients become scared when they see such cases in their relatives so i want to make them aware about coronary stenosis types and its management.