Hello, welcome everybody, this is Doctor Bolad.
Today I will talk to you about the decision making process to use either heart stents
or bypass surgery in patients with blocked or narrowed coronary arteries.
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cardiologist, and here on this channel you will find lots of education about heart health
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So let us get started with this video about heart stents compared to bypass surgery.
Patients with blockage in one or more of the coronary arteries need to be revascularized,
which means that they need the blood supply restored to the part of the heart muscle affected
by the blockage.
This is done by one of two ways, either by placing a stent by a procedure known as Percutaneous
Coronary Intervention, referred to for short as PCI or by bypassing the blockage by open
heart surgery by a procedure known as Coronary Artery Bypass Surgery, referred to as CABG
for short.
There are important differences between the two procedures, and these come into the decision
making process of which procedure to use.
Stenting is a less invasive procedure than bypass surgery, the patient is awake during
the procedure and sometimes sedated, and the patient is discharged home from hospital usually
on the same day or the following day of stenting.
The recovery period is short and within a few days the patient is back to his or her
normal self and can go back to work as usual.
The patient will continue to take aspirin for life and another blood thinner generally
for a few months.
By contrast, bypass surgery is a major surgical procedure, requires general anesthesia and
requires opening the chest wall to reach the heart and bypassing the blockages by arteries
or veins from other parts of the body.
The patient stays in the hospital for a few days, and when discharged requires a few weeks
of rehabilitation to get back the status before surgery, and needs a few weeks before he or
she can go back to work.
So how do we choose which procedure to use for our patients, and why do we still refer
patients for open-heart bypass surgery, rather than putting stents which are less invasive?
Our decision is based on many factors for best long-term outcomes based on data we have
accumulated over the years from hundreds of thousands of patients who had undergone both
procedures and is also based on data obtained from research.
Before we discuss this, let us first talk about who needs either of these revascularization
procedures, in the first place.
Revascularization with either stenting or bypass surgery, as opposed to continuation
of medical therapy, is needed for: - patients with activity-limiting symptoms
despite maximum medical therapy.
- active patients who want stenting for improved quality of life compared to medical therapy,
such as those who are not tolerating medical therapy well, or who want to increase their
activity level.
- patients with anatomy for which revascularization has a proven survival benefit such as significant
left main coronary artery disease who have greater than 50 percent narrowing, or multiple
coronary artery disease with over 70% narrowings with a reduction of heart left ventricular
pumping function and a large area of heart muscle not receiving enough blood supply.
Before choosing stenting or bypass, the patient should be informed about procedural risks
including that of death, stroke, and the need for repeat revascularization.
Stenting is generally performed on the following patients, although there might be exceptions.
- In patients with single artery disease, the recommendation is to perform stenting
using drug coated stents.
- In patients with two coronary artery disease involving the right and circumflex coronary
arteries, good outcomes are achieved with stenting using drug coated stents.
- In patients with narrowing of all the three main arteries, bypass surgery generally provides
better long term outcomes compared to stenting.
however, in those individuals with simple blockages and who are not diabetic, stenting
is also reasonable.
- In patients who refuse bypass surgery or for whom it is not an option based on other
diseases or poor functional status, stenting may be reasonable to improve the quality of
life irrespective of disease complexity.
- In patients with high risk of death from bypass surgery, stenting is performed.
Open heart bypass surgery is recommended for: - patients with two or three main coronary
arterial disease in whom complete revascularization cannot be accomplished by stenting, bypass
surgery would be preferable.
- patients with blockages in all three main coronary arteries, especially in diabetic
patients.
- patients with disease of the left anterior descending artery in addition to either the
right or circumflex coronary arteries, when the patient suffers from diabetes, best long
term outcomes are achieved by bypass surgery, especially when a large amount of heart muscle
is supplied by the diseased narrowed vessels.
-in patients with two or three main coronary arterial disease, who have reduced heart function,
bypass surgery would be preferable.
In some patients, after considering the factors I mentioned, it is occasionally not clear
whether stenting or bypass should be performed.
In this case we either recommend stenting or ask the patient whether he or she has a
preference after discussing the risks and benefits of both procedures.
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This is Doctor Bolad, helping you with your heart health, thanks for watching, and talk
to you soon.