SafeHomeDIY
  • Home
  • Health
    • Health Today
    • Women’s Health
    • Safety
    • Health & Fitness
    • Weight Loss
  • Nutrition
    • Diet
    • Food & Recipe
    • Skin Care
  • Allergies & Diseases
    • Autism
    • Remedies
  • Pets
  • News
  • #COVID-19
  • Guest Post
SafeHomeDIY
Subscribe
SafeHomeDIY
  • Home
  • Health
    • Health Today
    • Women’s Health
    • Safety
    • Health & Fitness
    • Weight Loss
  • Nutrition
    • Diet
    • Food & Recipe
    • Skin Care
  • Allergies & Diseases
    • Autism
    • Remedies
  • Pets
  • News
  • #COVID-19
  • Guest Post
  • Health
  • Health & Fitness

Is angioplasty plus stenting or coronary artery bypass surgery better for treating left main coronary artery disease?

  • April 29, 2020
  • SafeHomeDIY
atherosclerosis in coronary artery

One of the most dangerous places to have a coronary blockage is in the left main coronary artery. Why is a blockage there so precarious?

To answer that, let’s start with some basic cardiac anatomy. The two major coronary arteries — the blood vessels that supply blood to the heart — are the left and right coronary arteries. The left main coronary artery (LMCA) is the very first portion of the left coronary artery. It provides oxygenated blood to most of the left ventricle, which is the main pumping chamber of the heart.

Any amount of blockage in the LMCA, such as from plaque buildup or a clot, is referred to as “LMCA disease.” However, treatment is only needed when there is a blockage of 50% or more. At that level, there is an increased risk of death, a major heart attack, or a life-threatening arrhythmia (irregular heartbeat). That’s why it needs to be treated quickly after a blockage is detected.

But what exactly is the best treatment of LMCA disease? This is the source of a lot of recent and ongoing controversy.

Treatment options for LMCA disease

Currently, there are three options for treating LMCA disease:

  • Coronary artery bypass grafting, also known as bypass surgery or CABG, in which a blood vessel taken from a person’s leg, arm, or chest is moved and used to reroute blood around a clogged coronary artery.
  • Percutaneous coronary intervention, also known as angioplasty and stenting. In this procedure, a catheter with a deflated balloon and stent (a wire mesh device) at the tip is threaded into the heart through a blood vessel in the leg or wrist. The balloon inflates along with the stent, clearing the blockage. The stent is left in place to prop open the blood vessel.
  • Medical (drug) therapy.

Medical therapy is used in combination with both bypass surgery and stenting to help improve long-term outcomes. However, medical therapy alone has been shown to have worse outcomes in managing LMCA disease.

When comparing bypass surgery and stenting, there are some pros and cons to each. Stenting is much less invasive than bypass surgery, and has a significantly quicker recovery time. However, studies have shown that patients who have very complex LMCA disease (based on specific anatomic features) have better results with bypass surgery in the long term. But when there is less anatomic complexity, there is some uncertainty regarding which treatment is better.

Recent studies: More data, but no clear answers

Two recent clinical studies (NOBLE and EXCEL) compared bypass surgery and stenting in the low and intermediate anatomic complexity groups, and found two different results.

Let’s start off with the NOBLE study, which compared stenting to bypass surgery with regard to the combination of death, heart attack, need for repeat stenting or bypass surgery, and stroke after five years in patients with LMCA disease. It found that stenting was worse than bypass surgery for this combination of outcomes. However, the difference was mainly due to stenting patients having a higher rate of heart attacks and needing repeat stenting or bypass surgery. There was no difference in death or stroke between the two groups.

The EXCEL study also compared patients who underwent stenting with those who underwent bypass surgery for LMCA disease, but looked at the combination of death, stroke, and heart attack after five years; unlike NOBLE, the main endpoint of this study did not include the need for repeat stenting or bypass surgery. This study found no difference between the two treatments for the main endpoint. The stenting group had a slightly higher rate of death, but it wasn’t due to cardiac causes. (There were slightly more patients in the stenting group who died from infection and cancer, which was felt to be unrelated to the procedure.) Similar to NOBLE, EXCEL also found that patients undergoing stenting had higher rates of needing bypass surgery or repeat stenting. There was no difference in stroke rates.

A recent meta-analysis (a study that pools together and analyzes many studies) found that bypass surgery and stenting were equal in terms of death, heart attacks, and stroke for the low- and intermediate-complexity groups. However, patients undergoing stenting required slightly more repeat stenting or bypass surgery afterwards.

Final takeaway

Ultimately, what are patients with LMCA disease to do? Based on the data, patients who have anatomically complex LMCA disease should undergo bypass surgery, if possible. In patients with low or intermediate anatomic complexity, shared decision-making between patients, cardiologists, and heart surgeons is required to determine the best treatment option for each individual patient.

Some patients may be too frail or may have medical conditions that prevent them from undergoing bypass surgery. Other patients may not want the longer recovery process associated with bypass surgery, and those patients could be considered for stenting. Otherwise, bypass surgery would be a very good option.

Follow me on Twitter @DrDarshanDoshi

Source: Havard Health

Related Topics
  • Health
  • Heart Health
  • Surgery
SafeHomeDIY

Health - Relationships - Lifestyle Related matters. It's All About your Safety First - It's All About You

Previous Article
  • Food & Recipe

The ‘meat-free’ foods that are packed with HALF of your daily salt allowance

  • April 29, 2020
  • SafeHomeDIY
View Post
Next Article
  • Health

The real reason coronavirus is more devastating for elderly patients exposed

  • April 29, 2020
  • SafeHomeDIY
View Post
You May Also Like
View Post
  • Nutrition

Xylitol Benefits vs. Dangers

  • SafeHomeDIY
  • October 4, 2023
Costco's Pushy Sales Tactics Are Becoming a Major Nuisance For Loyal Customers
View Post
  • Health

Costco's Pushy Sales Tactics Are Becoming a Major Nuisance For Loyal Customers

  • SafeHomeDIY
  • October 4, 2023
View Post
  • Nutrition

Saffron Is Excellent for Long-Term Brain Health, Mood-Boosting Benefits, and (Of Course) Cooking

  • SafeHomeDIY
  • October 4, 2023
Everyone Is Making This "10/10" Trader Joe's Pizza
View Post
  • Health

Trader Joe's Shoppers Are Raving About An "Extremely Dangerous" Sweet Snack

  • SafeHomeDIY
  • October 4, 2023
Costco Shoppers Are Reporting Major Issues With the Store's Produce—Again
View Post
  • Health

Costco vs. Sam's Club: Which Has the Freshest Produce?

  • SafeHomeDIY
  • October 4, 2023
10 Daily Habits That Can Increase Testosterone
View Post
  • Health

10 Daily Habits That Can Increase Testosterone

  • SafeHomeDIY
  • October 4, 2023
Panera Just Launched 3 Brand-New Toasted Sandwiches
View Post
  • Health

Panera Just Launched 3 Brand-New Toasted Sandwiches

  • SafeHomeDIY
  • October 4, 2023
Yes, You Can Lose Weight Just by Walking—Here's How
View Post
  • Health

Yes, You Can Lose Weight Just by Walking—Here's How

  • SafeHomeDIY
  • October 4, 2023
Recent Posts
  • Steve Scalise Throws Hat into the Ring in House Speaker Race
  • Lori Harvey shows off her incredible legs in Chanel skirt and thigh-high boots at fashion show in Paris
  • Victoria & David Beckham's Remarks On His Alleged Affair Don't Answer Our Biggest Question
  • Scientists print functional SKIN for the first time, giving hope to burn victims and wounded veterans
  • Dr Michael Mosley recommends 'very tasty' food to reduce your bad cholesterol levels
Safe Home DIY
  • Guest Post
  • Disclaimer and Disclosure
  • Term of Use
Health - Relationships - Lifestyle Related matters. It's All About your Safety First - It's All About You

Input your search keywords and press Enter.