Harvard Heart Letter

Trial renews surgery vs. stent debate

A personalized approach is best for opening narrowed coronary arteries.

When cholesterol-filled plaque severely narrows a coronary artery and causes chest pain or other symptoms, there are two ways to immediately improve blood flow — angioplasty, usually with the placement of a wire-mesh stent, or bypass surgery. If the blockage is simple and confined to a single artery, angioplasty is often a good choice. It is quick and effective, and since it doesn't require opening the chest, the recovery time is short. For more severe or complicated problems, doctors have traditionally relied on bypass surgery. This has long been the approach taken for left main coronary artery disease, a blockage in the left coronary artery before it branches into two (see "Supplying the heart"). This is a serious problem because the left main coronary artery nourishes such a wide expanse of heart muscle. Bypass surgery has also traditionally been performed for three-vessel disease, which covers simultaneous blockages in the left anterior descending artery, the circumflex artery, and the right coronary artery.

Key points

  • Bypass surgery is a good choice for treating left main coronary artery disease or three-vessel disease, though angioplasty may be right for some people with these conditions.

  • Don't rush the decision — work with a surgeon and an interventional cardiologist to determine what's best for you.

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