This patient has basically a three-branch disease, the right coronary artery RCA, the left coronary artery two main branches of the left anterior descending branch LAD and the left circumflex branch LCX, there are obvious lesions, the heart is mainly divided into the three branches of the blood supply. the RCA in the middle of the section is not obvious contrast filling, this is considered to be the possibility of the blood vessel here is completely occluded, and at the same time, the left anterior descending branch and the left circumflex branch have 80% stenosis, and the formation of multiple calcium stenosis. The left anterior descending branch and left echogenic branch are 80% stenotic, and multiple calcified plaques have formed. Such a case is not an indication for intervention because first of all there are too many sites for you to intervene and it takes a long time to intervene, and the RCA is considered to be completely occluded and has multiple calcified plaques throughout, which is very long and very difficult for you to intervene to get through. At the same time you think about if you want to implant a stent, then you single stent so relatively easy, multiple stents have to be implanted then of course much more difficult, and each stent is a foreign body itself is prone to produce local irritation, will trigger platelet aggregation thrombosis, local tissue hyperplasia, this is even if you are very good implantation of the drug-eluting stent, the surgery is very good after the use of aspirin and clopidogrel Antiplatelet, then the restenosis rate is also high. It's also not cheap, much more expensive than a coronary bypass graft.
In general, intervention is indicated for patients who have a single site, a non-diffuse lesion, and where passage of the balloon stent is relatively easy, whereas coronary artery bypass grafting (usually cardiac bypass grafting) is just the opposite, and you mentioned this patient as an indication for the latter cardiac bypass graft.
Of course, before cardiac bypass, in addition to coronary angiography to further define the coronary artery situation or need to further myocardial metabolism imaging, generally can use PET, or there are high-quality SPECT can also be done, especially in this patient with the possibility of complete occlusion of the RCA, if the local blood-supplying myocardium did not survive, then you then through the blood vessels is not a great significance, because the dead myocardium, the dead heart of the patient's heart, the heart of the patient's heart. If the local blood supply is not viable, then there is no point in revascularizing it, because dead myocardium cannot be revived by restoring the blood supply. The only thing that you can do is to use laser myocardial perforation technology, but the results may not be so ideal.
Coronary artery bypass grafting can now generally be a small incision myocardial non-stop technology, the so-called off-PUMP technology, this is now more domestic three hospitals can do. As for the lock hole technology does not need to open the chest cavity, that this case is not suitable, because the lock hole technology is suitable for simple left anterior descending branch, after all, the field of vision is limited operation can not be too troublesome.