Stents vs. CABG for Heart Attack

Helpful Highlights

• A cardiac stent is a metal cage placed in the blocked coronary artery to open it and restore blood flow. A stent cannot be used in all cases.

• A coronary artery bypass graft (CABG) is a procedure wherein the blocked coronary arteries are clipped and rerouted ("bypassed") using vessels taken from elsewhere in the body.

• Stents are often used to prevent a major heart attack by opening partially blocked coronary arteries (at least 70% blockage, with special exceptions for less).

As a caregiver, you can support your loved one by learning as much as possible about the coronary vessels that are blocked and what was - or is going to be - done about it. Help them, as well as yourself, by going with your loved one to all provider appointments.  Many times, the information is so overwhelming that they will not remember some key points discussed and will hesitate to ask questions. With both of you listening, you’ll be able to prompt them to ask questions during the visit, as well as help them remember what the provider said.  With greater knowledge about the condition, the procedure, and the recommendations, you will be able to provide total support for your loved one.

Stent vs. coronary artery bypass graft (CABG or "bypass")

Which is best? It’s not a toss-up, but the right choice depends on several factors, and this question actually has a (general) answer – bypass (CABG) – provided your loved one's surgery risk isn’t too high.

Why?

The question of stent versus bypass (CABG) is really for those who have multi-vessel disease involving the three main coronary arteries.*  For three-vessel coronary disease, a bypass is superior to stents, with the possible exception of cases where the blocked part of the artery is very short.

The same is true when more than three vessels are involved; hence, "quadruple" bypass (four vessels), "quintuple" bypass (five vessels), and beyond.

In some cases, a combination of stent placement and bypass (CABG) surgery is done, which may be performed together - called hybrid coronary revascularization - or as separate procedures.

*The three main coronary arteries are taken to mean the left anterior descending (LAD) and the circumflex (Cx, also on the left) arteries - both of which branch from the left main coronary artery (LMCA) - and right coronary artery (RCA).

When stents are best

• When the left anterior descending (LAD) artery isn't involved, or at least when it isn't mostly or completely blocked.

• When there is a blockage in just one, maybe two vessels (but not the LAD). In this case, the cardiologist is likely to talk with your loved one about medical therapy versus stent placement. Medical therapy is medication, lifestyle changes, and follow-up visits without invasive interventions.

• When a bypass is no longer an option due to health status or surgery risk.

Bypass (CABG) is best for the most important artery - LAD

The three main coronary arteries are not all equal. The most important of them is the left anterior descending (LAD) artery. It supplies blood to the entire front wall of the heart, which represents much more muscle than the area fed by either of the other two arteries. It also represents the left ventricle - the heart's main pump that supplies blood to the brain and body. A narrowing or blockage in the LAD is, therefore, the most serious.

• Bypass (CABG) is the best choice for a mostly or completely blocked LAD. If the LAD is narrowed, and there are no other complicating factors, a stent might be used.

• A stent in the LAD only protects the area of the blockage, however. The rest of the artery is still vulnerable. A bypass (CABG) protects the downstream portion of that vessel, as well, usually for life.