Table of ContentsView AllTable of ContentsWhen Surgery Is NeededWhat Is Revascularization?BenefitsWhich Is Better?
Table of ContentsView All
View All
Table of Contents
When Surgery Is Needed
What Is Revascularization?
Benefits
Which Is Better?
There are risks and benefits to each approach. Your healthcare provider will also consider things like how many blockages you have and where they are. Your preference and your healthcare provider’s preference will be taken into account, too.
This article is focused on the different surgical treatment options for CAD and their risks and benefits.
Thierry Dosogne / Getty Images
CAD is a disease of the coronary arteries. These are the blood vessels that supply blood to the heart muscles so the heart can pump. Sometimes early CAD doesn’t produce symptoms. In some cases, it may causeangina(chest pain).
Disease in the coronary arteries puts you at risk for blood clots. These may block the blood flow to the heart muscle, causing aheart attack. They could also travel to the brain and interrupt blood flow, causing astroke. If you are diagnosed with CAD, you need the righttreatmentto reduce your risk of these life-threatening complications.
Medical therapies for treating CAD include:
Often, however, these aren’t enough to reverse CAD. In these cases, the diseased blood vessels may need to be surgically repaired. This can decrease the risk of death compared to medical therapy alone for people who have symptoms of CAD, and even for some who don’t.
What Are Coronary Arteries?
Stenting
Anangioplastyinvolves threading a wire to the coronary artery through a small puncture. The puncture is usually made in the groin or the arm. This procedure physically widens the diseased blood vessel.
Sometimes a stent is permanently inserted to keep the artery open. This is a small, tube-shaped device. Stents coated with medication help prevent blood clots and are associated with better survival than regular stents.
Angioplasty is considered minimally invasive. This means it is done using only small incisions.
What to Ask Before Getting a Stent for CAD
Bypass Surgery (CABG)
Sometimes, a portion of the coronary artery is replaced with a short part of one of your other arteries. An artery from your leg could be used, for example. This is called a graft.
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.
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:
Revascularization can also be a good option if you have pain that doesn’t seem to be improving with medication.
Deciding Which Is Better
Many factors will go into deciding which procedure could be safer or more effective for you. Both interventions may cause complications. This can include:
If you are diagnosed with CAD, your healthcare provider will refer you to a heart specialist called a cardiologist or to a heart surgeon. That specialist will weigh the following:
Stenting vs. CABGStentingMinimally invasivePreferred for emergenciesNot useful in all CAD casesFaster recoveryCABGInvasivePreferred for severe cases and multiple blockagesMore complete revascularization
Stenting vs. CABG
StentingMinimally invasivePreferred for emergenciesNot useful in all CAD casesFaster recovery
Minimally invasive
Preferred for emergencies
Not useful in all CAD cases
Faster recovery
CABGInvasivePreferred for severe cases and multiple blockagesMore complete revascularization
Invasive
Preferred for severe cases and multiple blockages
More complete revascularization
Stenting Pros and Cons
Stenting is a quick way to open a blocked artery. In an emergency, it is usually preferred over CABG. Anacute ST-segment elevation myocardial infarction (STEMI)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.
Do Angioplasty and Stents Improve Survival?
CABG Pros and Cons
If your coronary artery disease is severe, your healthcare provider may recommend CABG. CABG is believed to yield better long-term outcomes in people with three-vessel CAD.This is a serious form of CAD that involves all three major coronary arteries.
People with diabetes also tend to have better outcomes after CABG surgery than with stenting.
There are some situations that require CABG. Angioplasty might not be possible when a blood vessel is extremely frail and diseased, for example. It may also not be a good choice if the anatomy of the arteries is unusually complicated. Instead, your healthcare provider may determine that the vessel needs to be replaced.
Typically, CABG is considered to be a more complete treatment.
in general, except in cases of unusually difficult anatomy, outcomes with CABG and angioplasty tend to be comparable.
Summary
The choice between a stent and CABG will depend on many different factors. Your healthcare provider will consider the specifics of your disease, whether or not you have other diseases, and if you’ve tried medication.
In general, stenting has a shorter recovery time. Bypass surgery may be better for complicated cases. Both procedures can help reduce symptoms and have similar outcomes, though.
A Word From Verywell
Speak openly with your healthcare provider about your questions and concerns. Ask why one procedure may be recommended over the other. The path ahead starts with confidence in your treatment decisions.
9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Zimmermann FM, Omerovic E, Fournier S, et al.Fractional flow reserve-guided percutaneous coronary intervention vs. medical therapy for patients with stable coronary lesions: meta-analysis of individual patient data.Eur Heart J.2019;40(2):180-186.doi:10.1093/eurheartj/ehy812
Gu D, Qu J, Zhang H, Zheng Z.Revascularization for coronary artery disease: principle and challenges.Adv Exp Med Biol.2020;1177:75-100. doi:10.1007/978-981-15-2517-9_3
Yang Q, Lei D, Huang S, et al.Effects of the different-sized external stents on vein graft intimal hyperplasia and inflammation.Ann Transl Med.2020;8(4):102. doi:10.21037/atm.2020.01.16
Kuno T, Ueyama H, Ando T, Briasoulis A, Takagi H.Antithrombotic therapy in patients with atrial fibrillation and acute coronary syndrome undergoing percutaneous coronary intervention; insights from a meta-analysis.Coron Artery Dis.2021;32(1):31-5. doi:10.1097/MCA.0000000000000900
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