By Christopher Leet, MD, FACC Emeritus
When it comes to treating arterial blockages by bypass versus stenting, we are asking a trick question: Neither one is better. Rather, the procedures complement each other to reduce coronary blockages.
Most commonly under an acute situation, there are one or two major blockages which occur shortly after the origin of the coronary arteries from the aorta. If time is of the essence due to a very unstable clinical situation with chest pain and EKG changes, the most efficacious approach is to insert a small catheter with a mesh-tipped balloon on the end into the artery’s opening. At the point of blockage, doctors inflate the balloon, reopening the artery. After deflating the balloon, doctors leave the mesh in place as a stent to hold the artery open. This procedure can be done within an hour and under local anesthetic. The patient can usually go home the next day.
Occasionally, in more chronic situations, blockages may be more diffusely spread. This makes it difficult to get a stent to all of the offending blockages, requiring a coronary bypass instead. In this procedure, the chest (usually the sternum) is opened under general anesthesia, and other arteries or veins from elsewhere in the body are used to form bypass grafts, getting blood around the blockages so it can flow to and from the heart.
Conceptually, both procedures can be looked on as a “plumbing” correction. The “pipes” are obstructed, and the “plumber” relieves the obstructions by clearing a path through them or by rerouting them.
A stent procedure is certainly much easier to do, but the evidence suggests that in people with more severe blockages or complicating factors such as diabetes, coronary bypass may be the preferred process, since it tends to be a more permanent solution. Of course, there can be complications with either procedure, which doctors weigh against the severity of the situation and the patient’s medical history.
Manassas resident Dr. Christopher Leet, now retired, practiced medicine for nearly 40 years, specializing in cardiology and internal medicine.