Hello,
Thank you for your query at DoctorSpring.com and my sincere apologies for the delay with replying to your consult.

I have seen your angiographies. Your surgeon should have done grafting of the High OM vessel and Ramus at the time of bypass surgery. He could also have tried grafting of the diagonal artery at that time. The lesions in these arteries have progressed and may probably be causing the left arm pain on exertion. I dont see any suitable area for stenting. If your cardiologist wants to stent LCX he will end up giving competitive flow in the Graft to OM as there is no significant lesion in OM itself. Also the distal LCX receives blood flow from the OM graft. There is a lesion of about 60 percent in distal LCX just at the OM bifurcation. But that is not significant enough to merit stenting. Also the lesion mat be appearing more than it actually is due to competitive flow from OM graft. Medical therapy would be best forr the OM Ramus and diagonal lesions.
Hope this helps, please feel free to discuss further.
Regards
Dr Vivek Mahajan
DM Cardiology (PGIMER)
MD Medicine (AIIMS)