Coronary artery disease (CAD) is a condition of the coronary arteries, which are the vessels that supply blood to the heart muscles so the heart can pump. Disease in the coronary arteries can lead to blocked arteries that threatens the heart’s blood supply, causing a heart attack, or travel to the brain and interrupt blood flow, resulting in a stroke. It is the most common type of heart disease.
A common symptom of coronary artery disease is Angina- feeling of chest discomfort which also described by people as chest pain, tightness, heaviness, burning or a sense of squeezing.
CAD can be treated using procedures such as stents or bypass surgery. According to Dr. Vaibhav Mishra, a cardiothoracic and vascular surgeon at Fortis Hospital, Noida, India, “the decision to go for stents or bypass is based on number of factors- acuteness of presentation, age, comorbidities, diabetes, and number of vessels involved.”
Stenting
The process of stenting is commonly used to treat acute heart attacks and narrowed arteries. It is also called percutaneous coronary intervention (PCI). It involves threading a wire is inserted into a blood vessel, usually in the groin or the arm and maneuvered into the heart. This procedure is done to widen the blood vessel.
Bypass surgery (CABG)
Coronary artery bypass graft (CABG) is the surgery procedure to get access to your heart by making an incision in your chest. Considered a major procedure, Coronary artery bypass grafting surgery is often referred to as open-heart surgery. During the open-heart surgery, an artery or vein taken from elsewhere in the body is stitched in place to reroute blood around the blocked artery.
There are many factors involved when it comes to deciding which procedure could be safer or more effective for you. When considering treatment options, the following points are to be taken into consideration:
- Severity of your condition
- How many vessels need repair
- Presence/history of other illnesses (such as diabetes, arrhythmias, or previous heart attacks)
- Whether you have already tried conservative medical management
“Due to certain known and unknown factors, there develop blockages in coronary arteries, thus impeding the blood flow to the heart. This can be fixed by treating the blockage to normalise the blood supply called as ‘Revascularization’, that is done in two ways- via stent or bypass surgery and these two are fundamentally different techniques”, says. Dr. Mishra.
When stents are better
“Stents are better with blockage of one or two vessels”, explains Dr. Mishra. Furthermore, if you have a type of heart attack known as acute ST-Segment elevation myocardial infarction (STEMI), stenting can be a life-saving intervention because it’s a quick way to open the blocked artery.
Another advantage of stenting is that stents come in different sizes, shapes, and materials, which can give your doctor options when it comes to your treatment. Though stents are less risky for patients in the first month or so after the procedure, they are more risky- with a greater chance of heart attack and death—in the years following.
The recovery time with stenting is also faster than traditional open-heart bypass surgery and is much less likely to trigger strokes.
However, “sometimes location of the blockages is such that stenting is not possible and you may be referred to a cardiac surgeon for a bypass surgery”, says Dr. Mishra. “Generally bypass can be done on each and every patient regardless of disease factors ,however in one setting Angioplasty or stenting is always better viz emergency situations; similarly in very old patients with multiple risk factors who may not be suitable for surgery would fare better with stents.”, Dr. Mishra says.
When CABG is better
For three-vessel or multiple vessel blockages, coronary artery bypass graft (CABG) or bypass surgery is considered better than stenting. CABG is believed to yield better long-term outcomes in people with three-vessel CAD.
One of the three vessels in the heart is called left anterior descending artery (LAD). A narrowing or blockage in the LAD is more serious than narrowing or blockage in the other arteries, and thus bypass surgery is usually the best treatment option for it. Complications are rare with a bypass surgery, and the procedure using the mammary artery lasts for decades.
CABG is preferred for patients with underlying conditions like diabetes, is also best for younger people.
Dr. Mishra explains that “bypass surgery generally lasts much longer and today with the advent of newer drugs and arterial grafts with bypass, the symptom free period would be 15-20 years plus.” “With bypass procedure, an average stay in hospital is 6 days as compared to 3 days for angioplaysty or stenting”, he adds.
Precautions to take post surgery
Whichever procedure to decide to go with, depending on the severity and type of condition, post surgery care is essential in both situations. “At the time of discharge all patients receive basic advice related to medications, diet, physiotherapy and lifestyle modifications; adhering to these guidelines is very important to prevent recurrence of the disease.”, says Dr. Mishra.
The decision between stenting and bypass surgery should be based on weighing the up-front risk of death and stroke with bypass surgery, with the long-term need for repeat procedures with stenting. A diagnosis of CAD is a major warning that you need to take care of your health. Speak openly with your doctor about your questions and concerns to determine what the best option for the patient is.
