Question

Multivessel Stenting Or Bypass Surgery - Which One To Opt For?

Dr.Sanjib Patra · Accepted Answer

The results of a study conducted by the Department of Medicine, University of Ulsan, Korea, show that multivessel coronary stenting can be performed with a high success rate along with an acceptable clinical outcome. Coronary stenting has proven itself to be an accepted means for treating obstructed coronary arteries. The need for multivessel coronary stenting has been inflated because of the larger number of patients with unfavourable cardiac profiles. Conventionally, bypass surgery is regarded as a standard means for relieving angina in cardiac patients with multivessel coronary disease as it could lead to downright revascularization. Further, it also allows a prolongation of lifespan in a specified subgroup of patients.

How are they performed: Despite the coming of modern generation of stents, patients with multiple stringent arteries in the heart receiving coronary after bypass has recovered better than those whose arteries were grafted with balloon angioplasty or stenting. This report is presented in the 64th Annual Scientific Session in the American College of Cardiology. This report echoes past studies which show that patients afflicted with multiple narrowed arteries receive better results with coronary artery bypass grafting, which is also known as CABG or bypass heart surgery. In case of multivessel stenting, which is known as angioplasty or percutaneous coronary intervention or PCI, a stent is put within the arteries to hold it wide open and facilitate the flow of blood.

Which one is better: In a new study, it is reported that patients with new stents are susceptible to 47% higher risk of any of the outcomes like death or cardiac arrest as compared to patients who undergo bypass surgery. In CABG, a vein or artery from other parts of the body is grafted on the constricted coronary artery for allowing easy blood flow to and from heart. This study reinforces present regulations that recommend CABG to treat patients with substantial constrictions in various arteries, a condition often termed as multivessel coronary artery ailment.

Renowned cardiologist Seung Jung Park from Asan Medical Centre in Seoul, South Korea opines that CABG is still a much-preferred option on the basis of their medical data. Another study known as Bypass Surgery Versus Everolimus-Eluting Stent Implantation for Multivessel Coronary Artery Disease or BEST trial deserves mention. It is one of the two randomly controlled trials for comparing bypass to angioplasty since the introduction of modernised stents that emits medication, which would prevent blood clot.

This study was implemented on 880 patients at 27 healthcare centres in four countries. Each patient had multivessel coronary artery disease and were determined to be equally eligible to go through either of the methods. Half of these patients were randomly chosen to be given angioplasty with everolimus-eluting stents, and the other half received bypass surgery.

All the patients were tracked for about five years and during this prolonged follow-up, angioplasty was related to a considerable upsurge in the incidence of myocardial infarction, target vessel revascularization and often death. Because, it is a more invasive process, bypass surgery is normally recommended only for patients afflicted with higher-risk constrictions in more than one artery.

If you are one of these patients and this concern plagues you, it is recommended to talk to your cardiologist without much delay.

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