Stents and coronary artery bypass grafting (CABG) treat blocked arteries and coronary artery disease (CAD). While stents are a less invasive option, CABG is a major surgery. Your health care provider will consider how many blockages you have and where they are located. The optimal treatment depends on your individual situation.
In some cases, the answer is obvious. However, there are cases where one option is not clearly better than the other. Each approach has risks and benefits. Your wishes will usually be considered along with your health care provider’s wishes, if possible.
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Why is surgery necessary?
Coronary artery disease (CAD) occurs when fatty deposits (called plaques) develop in the arteries that supply blood to the heart muscle. CAD increases the risk of blood clots, which can reduce or block blood flow to the heart (heart attack) or travel to the brain, causing a stroke. If diagnosed with CAD, appropriate treatment is required. Medical therapies to treat CAD include:
In many cases, drug treatment is not sufficient to reverse CAD and surgical repair is required.
Stents vs. bypass surgery
Revascularization A procedure that restores blood flow to seriously diseased arteries by unblocking them or creating new routes. This can be done as follows angioplasty (possibly including stent placement) or with coronary artery bypass grafting (CABG), also called open-heart surgery.
Stent placement
Angioplasty involves passing wires into the coronary arteries through small punctures. The puncture is usually done in the groin or arm. This procedure physically widens diseased blood vessels.
A stent may be permanently inserted to keep the artery open. This is a small tube-like device. Drug-coated stents help prevent blood clots and have a higher survival rate than regular stents.
Angioplasty is considered minimally invasive. This means that the surgery is performed using only small incisions.
Bypass surgery (CABG)
Coronary artery bypass grafting (CABG) is considered a major surgery. The surgeon makes an incision in the chest to access the heart. In this procedure, the surgeon cuts out the affected section of the artery and sutures the ends.
In some cases, a portion of a coronary artery may be replaced with a short section of another artery. For example, you can also use the leg arteries. This is called a graft.
decide which is better
Many factors are considered to determine which treatment is safer and more effective. Both interventions can cause complications. This includes:
If you are diagnosed with CAD, your health care provider will refer you to a heart specialist called a cardiologist or cardiac surgeon. The expert will consider:
Severity of CAD Number of blood vessels that need repair Whether you have already tried medication Presence or history of other diseases such as diabetes, arrhythmia, or previous heart attack
If the best option is not clear, your case may be presented at an interdisciplinary conference. This allows you to discuss your treatment plan with your entire team of healthcare providers.
Advantages and disadvantages of stenting
Stenting is a quick way to widen a blocked artery. In an emergency, it is usually preferred over CABG. Acute ST-elevation myocardial infarction (STEMI) is the most dangerous type of heart attack. If you suffer from this type of heart attack, angioplasty can save your life.
Another advantage of angioplasty and stenting is that stents come in a variety of sizes, shapes, and materials. This gives healthcare providers options when it comes to treatment.
Because angioplasty is less invasive, recovery is usually easier than CABG. However, this is considered a high-risk procedure. In rare cases, unexpected complications may occur. For example, if the bleeding is severe, you may need to switch to open surgery right away.
Advantages and disadvantages of CABG
If your coronary artery disease is severe, your healthcare provider may recommend CABG. CABG is thought to provide better long-term outcomes in patients with three-vessel CAD. This is a severe form of CAD that involves all three major coronary arteries.
Diabetic patients tend to have better outcomes after CABG surgery than stenting.
CABG may be necessary in some situations. For example, if the blood vessels are very weak and diseased, angioplasty may not be possible. It may also not be a good choice if the arterial anatomy is unusually complex. Instead, your health care provider may decide that the blood vessel needs to be replaced.
CABG is generally considered to be a more complete treatment.
In general, the results of CABG and angioplasty tend to be comparable, except in cases of unusually difficult anatomy.
Benefits of revascularization
In non-emergency treatment of CAD, both procedures can help significantly reduce symptoms. However, it is often not better than other types of treatments.
In general, non-emergency revascularization by either method does not improve survival. It’s also difficult to know whether it helps reduce the chance of subsequent heart attacks.
However, both stenting and CABG may improve outcomes in patients suffering from acute coronary syndromes. This term refers to an emergency heart condition, such as a heart attack. Both surgeries can improve outcomes for patients who:
Complex lesions of multiple coronary arteries Disease of the left main coronary artery (which provides the largest blood supply to the heart)
If pain does not improve with medications, revascularization may also be a good option.
summary
The choice between stents and CABG depends on a variety of factors. Your health care provider will consider the details of your illness, whether you have other illnesses, and whether you have tried any medications.
Recovery time for stent placement is generally shorter. Bypass surgery may be appropriate for complex cases. However, both procedures can help reduce symptoms and have similar results.