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Monday 28th May 2018

Bypass surgery or stents?

2nd September 2008

European cardiologists say that heart bypass surgery means that further surgery is unlikely for at least another decade, making it a better alternative to angioplasty in the treatment of clogged arteries.

heart surgery

Experts at the European Society of Cardiology meeting in Munich said that while bypass surgery and angioplasty offered comparable results, patients who had angioplasties were twice as likely to require another procedure within a year.

Heinz Drexel, professor of medicine at the University of Innsbruck in Austria and spokesman for the European Society of Cardiology, said surgery was a better option if further surgery was to be avoided for another decade.

Drexel, who was not connected to the research, said bypass surgery also entailed cracking open the chest.

Bypass surgery and angioplasty remain the two main options when arteries become blocked. The former reroutes blood vessels to detour around blockages, while an angioplasty is a non-surgical procedure in which a balloon is pushed into a blood vessel and inflated to squash the blockage.

The artery is then held open by a device called a stent.

The recent European study compared the effectiveness of open-heart surgery versus angioplasty in a trial of more than 3,000 patients in Europe and the United States.

Patients who had had single and multiple vessel blockages were studied, while those who had suffered acute heart attacks were excluded.

The study, funded by Boston Scientific which makes the drug-coated stent used in the trial, found that the patients receiving angioplasty needed an average of about five stents.

Death rates in the two groups were virtually the same after a year, meaning that the decision whether or not to have surgery had less to do with survival than with the desire to avoid further surgery.

Among angioplasty patients the death rate was 7.6% after a year, and 7.7% for bypass surgery patients.

But nearly 14% of the angioplasty patients needed another procedure after a year, compared with about 6% of surgery patients.

There was a slightly elevated risk of stroke for surgery patients compared with angioplasty patients. But any surgery carries an inherent stroke risk.

In January, a study published in the New England Journal of Medicine found that bypass surgery was still the best option for heart patients with more than one clogged artery.

Patients opting for an angioplasty should be warned that there is a much greater likelihood of repeat procedures, cardiologists say.

When drug-coated stents were first introduced in 2003, they became the fastest-selling medical device in recent history, until research emerged in 2006 showing that patients with the devices were more likely to develop potentially fatal blood clots months and even years after they were implanted.

Stents are now used only in certain patients with no other options.


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