Harvard Health Letter

Bypass better than stenting for diabetics?

The surgery can be a better option for some with this condition.

For people who have both diabetes and several blocked heart arteries, bypass surgery (rerouting blood flow around a clogged artery) may have a better result than stenting (widening a heart artery by inserting a wire mesh tube called a stent near the blockage). A study published in a recent issue of The New England Journal of Medicine found that bypass surgery resulted in fewer heart attacks and deaths than stenting. Bypass also reduced the likelihood of return trips to the hospital to fix new blockages.

So what is it about diabetes that can make the invasive surgery a better option than the less invasive stenting? "Diabetic patients—in particular, those with longstanding severe diabetes—are more likely to have diffuse coronary artery disease, meaning that large segments of the coronary artery are narrowed. That type of disease is less well suited for placement of a stent, and more amenable to bypassing the entire diseased segment," says cardiologist Dr. Deepak Bhatt, a professor at Harvard Medical School.

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