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Coronary Stenting or Heart By Pass Surgery for CAD

CAD or Coronary Artery Disease also called atherosclerosis is caused due to narrowing up of the arteries with fatty deposits or plaque resulting irregular flow of blood through them. This irregularity causes reduced blood supply to and fro from the heart and may lead to angina; angina is the uneasiness in the chest, arms, or lower jaw that occurs when deficient supply of blood flows to the heart muscle. Patients with CAD are at high risk of suffering from heart attack. 

Treatment for CAD

Coronary artery bypass surgery has been the standard procedure recommended by cardiologists until it was clinically proven that drug coated stents (procedurally also known as Angioplasty) too can be effectively equally effective in cases multiple artery blockages. In most of the cases coronary stenting offered faster post surgery recovery time for patients. 

What are these procedures? Bypass surgery is an invasive procedure where a healthy blood vessel is grafted around a blocked one resulting in bypassing the blood flow away from the unhealthy or effected vessel. On the other hand, Stenting or Angioplasty is a minimally invasive procedure where a small mesh tube is inserted into the blood vessel after opening/expanding it with a balloon-tipped catheter.

Before we discuss on what works best for a patient with CAD, it becomes important to understand that neither these approaches is necessary in patients with stable CAD. Doctors recommend medical therapy to relieve symptoms of angina, and yields comparable results in comparison with invasive treatment in terms of succeeding mortality or heart attacks.

Invasive treatments such as Coronary ByPass Surgery or Stents are suggested when - 

  • A patient is dealing with unstable/acute coronary syndrome or unstable angina
  • A patient with stable CAD but who do not respond to medical therapies
  • A patient with complex CAD; in a complex CAD situation the patient dealing with major blockage in his left main coronary artery or with significant obstructions in 3 other coronary arteries – left, right anterior and left circumflex

Coronary Stenting (Angioplasty) or Bypass Heart Surgery

Whether to go for either of these two procedures for CAD treatment majorly depends on the following situations that you may be facing – 

  1. No of arteries affected by CAD Individuals with multiple artery blockages, Bypass surgery fares significantly better compared to Angioplasty. According to a study (https://www.ncbi.nlm.nih.gov/pubmed/9426011) , patients with multiple blockages survived at least 5 years after bypass surgery - 74 percent, when compared with 72 percent of those who had a angioplasty.
  2. Is the patient suffering from diabetes or had a history of heart failure or is/was a smoker As per the same research depicted in point (a), heart patients with diabetes, and patients with other heart related issues such as heart failure & peripheral artery disease patient lived 19 days longer after bypass surgery than Angioplasty/Stenting. In addition to this, researchers also found that smokers with such issues also benefitted significantly from bypass in comparison with angioplasty. However, patients with no such conditions, angioplasty worked well.
  3. How soon the patient wants to be recovered post surgery? Angioplasty or Stenting procedures offer a quicker recovery time in comparison with the heart bypass. However, angioplasty is not recommended to all patients with CAD as mentioned in point (a). For patients with multiple vessel blockages, diabetes etc heart bypass surgeries offer higher survival outcomes. Angioplasty is recommended for patients with less-severe coronary artery disease (CAD).
  4. Cost of the procedure Bypass surgery typically costs higher against angioplasty. In India, heart bypass procedures typically costs between 3-4 lakhs, while angioplasty costs between 1-2 lakhs; approximately 100% lower than heart bypass surgery.

To summarize – Invasive procedure of Heart Bypass surgery is recommended for patients with complex CAD, while Non-invasive procedures such as angioplasty is preferred for patients with lower risk CAD. 

Still in doubt? Get second medical opinion from expert cardiologists for better diagnosis and treatment for your heart condition/s. 

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