Harvard Heart Letter

Should you have stenting or bypass surgery?

Many factors go into your physician's recommendation.

When fatty plaques threaten to obstruct the coronary arteries, there are two options for restoring blood flow (otherwise known as revascularization): open the blockages with a balloon (angioplasty), followed by the placement of a stent; or bypass the blockages with coronary artery bypass grafting (CABG).

Balloon angioplasty can open a narrowed artery, and the stent (an expandable wire mesh cylinder) can hold it open. Angioplasty and stenting is a minimally invasive, nonsurgical procedure with less postoperative pain, a shorter hospital stay, and faster recovery than CABG. So it's no surprise that its popularity has soared. But despite these advantages, it's not the best choice for everyone. Now that thousands of stents have been implanted, cardiologists better understand the long-term effects of the procedure and can make an informed decision about which treatment might be best for each individual.

Coronary Artery Bypass Grafting (CABG)

Coronary Artery Bypass Grafting (CABG)

Stenting: Who benefits?

Chest pain (angina) plays a key role in the decision to advise stenting or CABG, since it signals that blood flow to the heart is being restricted by narrowed or blocked coronary arteries. Angina that occurs during exercise and is relieved with rest or nitroglycerine is called stable angina. Chest pain that occurs spontaneously and at rest is called unstable angina. Unstable angina carries a much worse prognosis if the heart is not revascularized.

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