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Should You Choose a Drug-Eluting Stent Over Coronary Artery Bypass Grafting

Is One Better Than the Other?

This is a tricky question. The reason we say that is because there is not a clear answer that is right for everyone. The answer for which procedure is best will depend on a number of factors, including your particular heart problem, the severity of the problem, and your age, just to name a few. 
If you have severe blockages in your large coronary arteries and your heart's pumping action is growing weak, you may need to have a CABG. The results of CABG are often positive, with the surgery improving or completely relieving chest pain (angina) in most people. While symptoms can return and arteries can become blocked again, CABG can allow many people to remain symptom-free for as long as 10 to 15 years. CABG can also help lower your risk for a heart attack and help you live longer. Of course, medications and lifestyle changes can also help extend your lifespan as well.
While CABG is usually the treatment of choice for certain types of coronary artery disease, the PCI procedure has become a popular nonsurgical treatment. In particular, with the drug-eluting stents (DESs), PCI procedures have led to lower rates of early restenosis (the artery narrowing again) than the bare-metal stents (without medication on them). The development of DES had some experts hoping that this procedure would replace CABG entirely. 
However, that doesn't seem to be likely based on the results of research studies that have been done. The bulk of the findings of these studies have shown that although DES is far less invasive than surgery, CABG offers more complete re-establishment of blood flow (revascularization) and less likely a chance that a repeat revascularization would have to be done. 
Also, there is a lack of long-term data available on DES procedures at this time. On the other hand, CABG procedures have strong 10- and 20-year rates of successful results. There have also been some new advances in many aspects of the CABG procedure, which have improved short- and long-term outcomes. While PCI technologies will no doubt continue to advance, there is not enough data at this point to indicate that DESs will make CABG obsolete any time soon. 
The Achilles' heel of DES is restenosis and the need for repeat revascularization. This means that even with stenting, it is still possible for the coronary artery to renarrow. Drug-eluting stents greatly reduce the risk of restenois, compared to bare-metal stents. If restenosis occurs, another stent procedure or bypass surgery may be needed.  
While the advantages of DESs over bare-metal stents are fairly evident, there is still insufficient long-term clinical data to prove that DESs are preferable to CABG. This means that DESs are likely to provide better outcomes than bare-metal stents for many people (but not all) who would be best suited for a PCI procedure with a stent. However, there isn't enough information available to justify using DESs in people for whom CABG is the preferred recommendation. 
Life After a Stent: 5 Realistic Ways to Take Charge of Your Health

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