When Stents Are Best
When the LAD isn’t involved, stents are usually the first choice.
“If you’re talking about blockages in one or even two vessels, the talk with the patient is not so much about bypass versus stenting as about stenting versus medical therapy,” Cutlip says. Medical therapy here means medication and follow-up visits with your cardiologist, but no invasive interventions such as bypass or angioplasty.
There’s another time stents are the best choice: when bypass no longer is an option.
While LAD repair with a mammary artery usually lasts for the rest of a person’s life, CABG grafts in the other two arteries do not. These procedures typically use veins rather than arteries, and in half of people, these repurposed veins start to fail after eight to 10 years.
“Once that happens and you need more work, a second bypass can be done, but generally we prefer to use stents,” says Dr. Cutlip.
CABG best for patients with diabetes, other factors
For people with diabetes, there are fewer questions regarding the choice between bypass surgery and stents. Bypass surgery is generally superior to angioplasty.
When more than one heart artery is blocked, CABG may also offer better survival rates for people with heart failure.
Severe Blockage Of Artery Passage
As a consequence of the deposits on the walls of the arteries, there is an acute shrinkage of the vital passage through which the blood is pumped into the heart. This prevents smooth functioning of heart which subsequently affects blood supply throughout the whole body. It leads to severe pain in the chest as there is a decreased oxygen supply and this state is termed as Angina.
What Happens During Angioplasty
Angioplasty may be done as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices. Most people who have angioplasty and stent placement are monitored overnight in the hospital.
Generally, angioplasty follows this process:
You will be asked to remove any jewelry or other objects that may interfere with the procedure. You may wear your dentures or hearing aid if you use either of these.
You will be asked to remove your clothing and will be given a gown to wear.
You will be asked to empty your bladder before the procedure.
If there is a lot of hair at the area of the catheter insertion , the hair may be shaved off.
An IV line will be started in your hand or arm before the procedure. It will be used for injection of medicine and to give IV fluids, if needed.
You will be placed on your back on the procedure table.
You will be connected to an electrocardiogram monitor that records the electrical activity of your heart and monitors your heart rate using electrodes that stick to your skin. Your vital signs will be monitored during the procedure.
There will be several monitor screens in the room, showing your vital signs, the images of the catheter being moved through your body into your heart, and the structures of your heart as the dye is injected.
You will get a sedative in your IV to help you relax. However, you will likely stay awake during the procedure.
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Stents Or Bypass Surgery More Effective For Stable Patients With High
Location of blockages in a patients heart is a key consideration in selecting the right treatment, U of A cardiologists find.
Kevin Bainey led a new study showing that stent or bypass surgery along with medication led to a lower risk of death for patients with heart disease whose blood vessels had blockages in high-risk locations.
A new study by University of Alberta cardiologists at the Canadian VIGOUR Centre shows that a particular group of patients with stable ischemic heart disease have better outcomes with percutaneous coronary intervention or coronary artery bypass surgery and medication, versus conservative management with medication alone.
In a study published in the Journal of the American Heart Association, associate professor of medicine and academic interventional cardiologist Kevin Bainey and his team reviewed the patient information of more than 9,000 Albertans with stable ischemic heart disease. While able to function as outpatients, these patients had arteries in the heart that had narrowed and were restricting blood supply. They also had other heart issuesreferred to as high-risk cardiac anatomyincluding blockages in important locations of the hearts blood vessels, or restriction in the left main artery of the heart.
What our results are saying is that medical management is important, but there might be a small group that would benefit from revascularization, and we need to find ways to identify that group of patients, he said.
Heart Procedures And Surgeries
If you’ve had a heart attack, you may have already had certain procedures to help you survive your heart attack and diagnose your condition. For example, many heart attack patients have undergone thrombolysis, a procedure that involves injecting a clot-dissolving agent to restore blood flow in a coronary artery. This procedure is administered within a few hours of a heart attack. If this treatment isn’t done immediately after a heart attack, many patients will need to undergo coronary angioplasty or coronary artery bypass graft surgery later to improve blood supply to the heart muscle.
See diagnostic tests and procedures to better understand the tests you may have to undergo to find out if you had a heart attack, how much damage was done and what degree of coronary artery disease you have.
Pros And Cons Of Angioplasty
Angioplasty has several advantages over bypass surgery. In addition to being a relatively simple procedure, angioplasty has faster recovery rate, fewer complications, and lower costs. Also, after a stay of 1 to 2 days in the hospital, the patient can resume normal activities. For uncomplicated cases, angioplasty is now becoming the first choice for most of patients and cardiologists.
But the convenience that comes with the angioplasty often comes with a price. It is estimated that 15 to 20% of patients who have undergone angioplasty might be at the risk of narrowed arteries in a few years and eventually need bypass surgery. Also, in a case of the drug-eluting stent, the patient must take medication for a year to prevent the deadly clots to be formed around the stent.
Common Question Regarding Heart Bypass Surgery
Coronary Artery Bypass Grafting , commonly known as Heart Bypass Surgery, is a surgical procedure is carried out in cases where the artery blockage cannot be rectified by non-surgical procedures, namely coronary angioplasty. The decision to undertake this surgery is quite critical. Therefore, doctors take into consideration many factors including few discussed below:
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Coronary Artery Disease Treatment
Patients suffering from coronary artery disease are typically put on medications to improve lipid levels, lower blood pressure and prevent blood clots as well as advised to modify lifestyle to help prevent disease progression. According to cardiologists, adopting the following healthy lifestyle habits can prevent the progression of the disease and promote healthier arteries:
- Eat healthy foods
- Yoga and meditation
When medical management and lifestyle changes do not control coronary artery disease, the cardiologist may recommend a revascularization procedure heart bypass surgery or angioplasty.
A Comprehensive Approach To Heart Care
Jersey City Medical Center has made continuous investments in its heart program over the past decade.
Today, we provide all aspects of cardiac care, including care for heart failure and atrial fibrillation and lifesaving procedures like cardiac catheterizations and openheart surgery, says Tyrone Krause, MD. JCMCs heart team includes surgeons, cardiologists, interventional cardiologists, physician assistants, nurse practitioners and critical care specialists who provide care 24/7 inside the hospital, from presurgery to recovery.
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Looking At Quality Of Life
When researchers looked at angina and quality of life in study participants, overall, both groups fared well. In fact, slightly more than half of people in both groups reported substantial improvement in angina as early as one month after their procedures.
But when investigators looked at those measures across various time points, and in people with more and less severe disease, differences emerged.
As was expected, people who got stents generally felt better faster, compared to the group that had bypass surgery, probably because there was less healing time required after the less invasive procedure.
But by six and 12 months after their procedures, both groups reported nearly equal improvements in physical functioning, pain, vitality, and social and mental health.
And after six months, researchers say people that went into the study with daily or weekly chest pain experienced greater relief after CABG than did those who got PCI.
âAngina relief at six months and a year was better with bypass surgery, though the difference was small,â says Cohen. âBut there were clear differences in the early quality of life on a wide range of dimensions that clearly favored PCI, but those benefits were transient,â he says.
The study was sponsored by Boston Scientific, which produces paclitaxel-coated stents.
How A Coronary Angioplasty Is Performed
A coronary angioplasty is performed using local anaesthetic, which means you’ll be awake while the procedure is carried out.
A thin, flexible tube called a catheter will be inserted into one of your arteries through an incision in your groin, wrist or arm. This is guided to the affected coronary artery using an X-ray video.
When the catheter is in place, a thin wire is guided down the length of the affected coronary artery, delivering a small balloon to the affected section of artery. This is then inflated to widen the artery, squashing fatty deposits against the artery wall so blood can flow through it more freely when the deflated balloon is removed.
If a stent is being used, this will be around the balloon before it’s inserted. The stent will expand when the balloon is inflated and remains in place when the balloon is deflated and removed.
A coronary angioplasty usually takes between 30 minutes and 2 hours. If you’re being treated for angina, you’ll normally be able to go home later the same day or the day after you have the procedure. You’ll need to avoid heavy lifting, strenuous activities and driving for at least a week.
If you’ve been admitted to hospital following a heart attack, you may need to stay in hospital for several days after the angioplasty procedure before going home.
Read more about:
Read more about the possible complications of a coronary angioplasty.
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Balloon Angioplasty And Heart Stents
UT Southwestern Medical Centers skilled heart experts perform balloon angioplasty and heart stenting to open clogged and blocked heart arteries.
These minimally invasive procedures help restore blood flow to and from the heart and allow patients to avoid open-heart surgery.
Leaders in Heart and Vascular Care
Combining attentive, compassionate care with our extensive clinical and research resources, UT Southwestern’s cardiology experts and vascular specialists deliver individualized care within pre-eminent health care facilities.
Minimally Invasive Heart Surgery
and Minimally Invasive Coronary Artery Bypass Graft
What the Procedure Does
An alternative to standard bypass surgery . Small incisions are made in the chest. Chest arteries or veins from your leg are attached to the heart to “bypass” the clogged coronary artery or arteries. The instruments are passed through the ports to perform the bypasses. The surgeon views these operations on video monitors rather than directly. In PACAB, the heart is stopped and blood is pumped through an oxygenator or “heart-lung” machine. MIDCAB is used to avoid the heart-lung machine. It’s done while the heart is still beating. Requires several days in the hospital.
Reason for the Procedure
- Manages blockage of blood flow to the heart and improves the supply of blood and oxygen to the heart.
- Reduces risk of heart attack.
- Improves ability for physical activity.
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Heart Bypass Surgery Vs Angioplasty
While it may sound straightforward, the situation heart bypass surgery vs angioplasty is quite tricky. Typically, the surgeon uses the reports of coronary angiography to examine the degree of the arteries being blocked and based on the nature of the plagues and range of blockage of the arteries. On the basis of the reports, an experienced cardiologist weighs heart bypass surgery vs angioplasty pros and cons. The surgeon might also actively involve the patient and their caregivers to come to a common conclusion.
Most of the decisions of heart bypass surgery vs angioplasty are based on:
- Severity and extent of spread of coronary artery disease
- Presence of chest pain and shortness of breath
- Functioning of the heart
- Other co-existing medical conditions, such as diabetes, peripheral artery disease, or prior stroke or heart attack
- Patient & family preferences
Also, if you have undergone a heart bypass surgery, read about Healthy Lifestyle for Healthy Heart
As a rule of the thumb, angioplasty is suited for limited blockage with no coexisting medical conditions and when the chest discomfort is due to reduced blood flow that has not responded to medication and lifestyle changes. While, heart bypass surgery is suggested if the arteries are narrowed or blocked in multiple areas, or the main coronary artery is narrowed and the patient has other medical conditions like diabetes.
Should You Have Stenting Or Bypass Surgery
Many factors go into your physician’s recommendation.
When fatty plaques threaten to obstruct the coronary arteries, there are two options for restoring blood flow : open the blockages with a balloon , followed by the placement of a stent or bypass the blockages with coronary artery bypass grafting .
Balloon angioplasty can open a narrowed artery, and the stent can hold it open. Angioplasty and stenting is a minimally invasive, nonsurgical procedure with less postoperative pain, a shorter hospital stay, and faster recovery than CABG. So it’s no surprise that its popularity has soared. But despite these advantages, it’s not the best choice for everyone. Now that thousands of stents have been implanted, cardiologists better understand the long-term effects of the procedure and can make an informed decision about which treatment might be best for each individual.
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- Research health conditions
- Prepare for a doctor’s visit or test
- Find the best treatments and procedures for you
- Explore options for better nutrition and exercise
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When Cabg Is Recommended
While CABG can successfully treat any blockage, its especially recommended for:
- People with a severe blockage in the hearts largest artery .
- People with multiple blocked arteries .
CABG may also be the best option when an artery is too calcified to support a stent, or when its technically too difficult to place a stent in an artery, Dr. Krause explains.
Most patients who undergo CABG will not need blood thinners. Patients who are treated with stents will need to take bloodthinning medication for at least three months to prevent stents from closing. Sudden closure of the stents can damage the heart muscle, explains Iosif Gulkarov, MD, Associate Chief of Cardiac Surgery at JCMC and a member of RWJBarnabas Health Medical Group.
Ask your care team about your overall heart condition, your risk for surgery and your risk of restenosisa chance of narrowing againwith a stent, Dr. Krause says. Use the answers to make the best choice for you.
Stenting Pros And Cons
Stenting is a quick way to open a blocked artery. In an emergency, it is usually preferred over CABG. An acute ST-segment elevation myocardial infarction is the most dangerous kind of heart attack. If you have this kind of heart attack, an angioplasty can save your life.
Another advantage of angioplasty and stenting is that stents come in different sizes, shapes, and materials. This gives your healthcare provider options when it comes to your treatment.
Angioplasty is minimally invasive, so the recovery is usually easier than it is with CABG. It is considered a high-risk procedure, however. Rarely, unexpected complications can occur. For example, severe bleeding could mean the procedure needs to be rapidly converted to open surgery.
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How Is Coronary Angioplasty Done
Before coronary angioplasty is done, your doctor will need to know whether your coronary arteries are blocked. If one or more of your arteries are blocked, your doctor will need to know where and how severe the blockages are.
To find out, your doctor will do an angiogram and take an x-ray picture of your arteries. During an angiogram, a small tube called a catheter with a balloon at the end is put into a large blood vessel in the groin or arm. The catheter is then threaded to the coronary arteries. A small amount of dye is injected into the coronary arteries and an x-ray picture is taken.
This picture will show any blockages, how many, and where they’re located. Once your doctor has this information, the angioplasty can proceed. Your doctor will blow up the balloon in the blockage and push the plaque outward against the artery wall. This opens the artery more and improves blood flow.
The illustration shows a cross-section of a coronary artery with plaque buildup. The coronary artery is located on the surface of the heart. Figure A shows the deflated balloon catheter inserted into the narrowed coronary artery. In figure B, the balloon is inflated, compressing the plaque and restoring the size of the artery. Figure C shows the widened artery.
A small mesh tube called a stent is usually placed in the newly widened part of the artery. The stent holds up the artery and lowers the risk of the artery re-narrowing. Stents are made of metal mesh and look like small springs.
The Benefits Of Revascularization
For non-emergency treatment of CAD, both procedures can help significantly reduce symptoms. Often, though, they are not better than other kinds of therapy.
Generally speaking, non-emergency revascularization by either method doesn’t improve survival. It is also difficult to know if it helps reduce the rate of subsequent heart attacks.
However, both stenting and CABG can improve outcomes for patients who are experiencing acute coronary syndrome. This term describes an emergency heart condition like a heart attack. Both procedures can also improve outcomes for patients who have:
- Complex lesions in several coronary arteries
- Disease of the left main coronary artery
Revascularization can also be a good option if you have pain that doesn’t seem to be improving with medication.
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