Features October 2017 Issue

For Severe Coronary Artery Disease, Bypass May Be Best

A Cleveland Clinic study found that long-term outcomes and quality of life are better with CABG compared with stenting in complex CAD cases.

The decision to treat blocked arteries in the heart with angioplasty and stenting or coronary artery bypass grafting (CABG) usually depends on several factors. The location and severity of the blockage are among the main considerations.

A recent Cleveland Clinic study suggests that in at least two situations, CABG is the better choice. Researchers led by Mouin S. Abdallah, MD, found that if three of your coronary arteries or your left main coronary artery are blocked, CABG will lead to fewer adverse events and a better quality of life during the next five years compared with angioplasty and stenting. With angioplasty, a catheter is inserted into a blood vessel and guided into the heart to the site of the blockage. A tiny balloon at the tip of the catheter is inflated, opening up more room for blood flow in the artery. In many cases, a stent is left in place to help keep the artery open. In recent years, more and more of the stents being used are coated with a special drug designed to keep tissue from forming around the mesh stent, leading to narrowing again.

Bypass

(c) Banol2007 | Dreamstime.com

In coronary artery bypass surgery (CABG), a surgeon takes a blood vessel from another part of the body—often a vein from the leg—and attaches or grafts it to the heart above and below the blocked portion of the coronary artery. This CT scan highlights the surgically attached blood vessel, which carries blood around the blocked artery.

“Both CABG and angioplasty with drug-eluting stents were associated with substantial and sustained quality-of-life benefits over five years of follow-up,” Dr. Abdallah says. “But CABG provided greater relief from angina at five years, primarily among patients with anatomically complex disease.”

Understanding CAD

The left main coronary artery is one of the heart’s two main arteries. The other is the right coronary artery. They supply blood to the heart muscle through a network of smaller coronary arteries. Blockage in any of your coronary arteries is called coronary artery disease (CAD), and it’s a precursor to a heart attack.

The study, which included 1,800 patients, suggests that the more complex the CAD is, the less effective stenting was at relieving symptoms, such as angina, which is chest pain caused by reduced blood flow to the heart muscle. Dr. Abdallah adds that stenting is still an excellent option for many patients. The key is to review the pros and cons with your doctor.

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