Stents vs. Bypass Surgery for Treating Coronary Artery Disease

What factors into choosing one option over the other

In This Article

Coronary artery disease (CAD) can be treated with medical management or with procedures such as stents or bypass surgery. Deciding on the best treatment option for you is a highly nuanced issue because there are risks and benefits to each approach.

One of the major areas of CAD research is focused on whether there is a clear difference between the outcomes of medical treatment, stents, or bypass surgery and which conditions favor one option over the other. There are some situations when the answers are clear, but there are also grey areas when one option is not definitively better than the others.

If you and your doctor are weighing your CAD treatment choices, it can help for you to know where the current research stands.

bypass surgery
Thierry Dosogne/Getty Images

When Surgery Is Needed

CAD is a disease of the coronary arteries, which are the vessels that supply blood to the heart muscles so the heart can pump. Sometimes early CAD doesn't produce symptoms, but it may cause angina (chest pain).

Disease in the coronary arteries predisposes you to blood clots, which may block the blood flow to the heart muscles (causing a heart attack) or travel to the brain and interrupt blood flow, resulting in a stroke.

If you are diagnosed with CAD, it is vital that you receive appropriate treatment to reduce your risk of these life-threatening complications.

Medical therapies include prescription blood thinners, high cholesterol treatments, antihypertensives, and medications that help manage heart disease. But, often, these aren't enough to reverse CAD.

In these cases, the diseased blood vessels may need to be surgically repaired. For people who have symptoms of CAD, and even for some who don't experience symptoms, a procedure can decrease the risk of death compared to medical therapy alone.

Revascularization is a process by which a severely diseased artery is cleared of blockage through an interventional procedure. Areas of significant obstruction in the coronary arteries can be opened with angioplasty and stent placement or with coronary artery bypass grafting (CABG).

Stenting

An angioplasty involves threading a wire to the coronary artery through a small arterial puncture, usually in the groin or the arm.

This minimally invasive procedure is used to physically widen the diseased blood vessel. Sometimes a stent—a small device that's shaped like a short section of an artery—is permanently inserted to keep the artery open.

Drug-eluting stents coated with medication help prevent blood clots and are associated with better survival than regular stents.

Bypass Surgery (CABG)

If you need to have a coronary artery bypass grafting (CABG), your surgeon will get access to your heart by making an incision in your chest. The artery in your heart will be directly repaired as the surgeon removes the diseased section (or sections) and sutures the ends back together.

Sometimes, a portion of the coronary artery is replaced with a short portion from one of your other arteries, such as an artery from your leg.

Coronary artery bypass grafting surgery is often referred to as open-heart surgery. It is considered a major procedure.

Deciding Which Is Better

There are many factors involved when it comes to deciding which procedure could be safer or more effective for you. Both types of interventions may cause health complications, including heart attacks, cardiac arrhythmia (irregular heartbeat), and stroke.

If you are diagnosed with CAD, your primary care doctor will refer you to a cardiologist (heart specialist) or to a heart surgeon. That doctor will weigh the following when considering these treatment options:

  • Severity of your CAD
  • How many vessels need repair
  • Presence/history of other illnesses (such as diabetes, arrhythmias, or previous heart attacks)
  • Whether you have already tried conservative medical management

When the best therapeutic option isn't clear, your case may be presented in a multidisciplinary conference so that your treatment plan can be discussed by a whole team of doctors.

Stenting
  • Minimally invasive

  • Preferred for emergencies

  • Not useful in all CAD cases

  • Faster recovery

CABG
  • Invasive

  • Preferred for severe cases

  • More complete revascularization

  • Superior survival rates

Stenting Pros and Cons

Stenting is generally preferred over CABG in emergency situations. If you have a type of heart attack known as acute ST-Segment elevation myocardial infarction (STEMI), angioplasty can be a life-saving intervention because it's a quick way to open the blocked artery.

Another advantage of angioplasty and stenting is that stents come in different sizes, shapes, and materials, which can give your doctor options when it comes to your treatment.

Because the procedure is minimally invasive, the recovery process after angioplasty is not typically as taxing as it is after a CABG.

It is considered a high-risk procedure, however. Rarely, an unexpected complication may occur, such as severe bleeding, and the procedure might need to be rapidly converted to open surgery.

CABG Pros and Cons

An open surgical procedure may be recommended if your coronary artery disease is severe. For example, CABG is believed to yield better long-term outcomes in people with three-vessel CAD.

There are some situations that require CABG. When a blood vessel is extremely frail and diseased, or if the arterial anatomy is unusually complicated, angioplasty might not be possible and the vessel may need to be replaced.

Typically, CABG is considered the method that provides more complete revascularization.

In general, people revascularized with CABG don't need to have repeat revascularization as often as people who have angioplasty and stents. Long-term studies suggest that CABG can improve survival when compared to angioplasty and stenting.

A Word From Verywell

A diagnosis of CAD is a major warning that you need to take care of your health. Often, by the time CAD is diagnosed, the risk of a heart attack or stroke is very high and an interventional procedure may be necessary.

Speak openly with your doctor about your questions and concerns, and ask why one procedure may be recommended over the other. The path ahead starts with confidence in your treatment decision.

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Zimmermann FM, Omerovic E, Fournier S, et al. Fractional flow reserve-guided percutaneous coronary intervention vs. medical therapy for patients with stable coronary lesions: meta-analysis of individual patient data. Eur Heart J. 2019;40(2):180-186.doi:10.1093/eurheartj/ehy812

  2. Lee K, Ahn JM, Yoon YH, et al. Long-term (10-year) outcomes of stenting or bypass surgery for left main coronary artery disease in patients with and without diabetes mellitus. J Am Heart Assoc. 2020;:e015372.doi:10.1161/JAHA.119.015372

  3. Bangalore S, Guo Y, Samadashvili Z, Blecker S, Xu J, Hannan EL. Everolimus-eluting stents or bypass surgery for multivessel coronary disease. N Engl J Med. 2015;372(13):1213-22.doi:10.1056/NEJMoa1412168

  4. Gu D, Qu J, Zhang H, Zheng Z. Revascularization for coronary artery disease: Principle and challenges. Adv Exp Med Biol. 2020;1177:75-100.doi:10.1007/978-981-15-2517-9_3

  5. Yang Q, Lei D, Huang S, et al. Effects of the different-sized external stents on vein graft intimal hyperplasia and inflammation. Ann Transl Med. 2020;8(4):102.doi:10.21037/atm.2020.01.16

  6. Kuno T, Ueyama H, Ando T, Briasoulis A, Takagi H. Antithrombotic therapy in patients with atrial fibrillation and acute coronary syndrome undergoing percutaneous coronary intervention; insights from a meta-analysis. Coron Artery Dis. 2020;April 16.doi:10.1097/MCA.0000000000000900

  7. Melly L, Torregrossa G, Lee T, Jansens JL, Puskas JD. Fifty years of coronary artery bypass grafting. J Thorac Dis. 2018;10(3):1960-1967. doi:10.21037/jtd.2018.02.43