Questions about bypass and stent and the answers
Factors such as smoking, high cholesterol, hypertension, diabetes or genetics… These factors lead to the physician’s door by causing obstruction in coronary artery(ies). In some cases of obstructed coronary artery(ies), bypass surgery is inevitable. You may have many questions such as, which situations require bypass or how do stents work. Questions about bypass and stent and the answers…
What are the conditions which lead to bypass surgery? Is a patient with past history of three by-pass surgeries at higher risk than another patient who underwent only one bypass surgery?
Bypass may be the only curative option, if the underlying factors of obstructed coronary artery(ies) are diffuse and left untreated, there are numerous obstructions and they are high-grade and a less invasive treatment is not started in a timely manner. The surgery is more complex, if there are too many lesions and the obstruction covers a long segment. Since the number of bypassed arteries increase and by-pass surgery becomes necessary for proximal and/or distal ends, the risk of surgery raises.
Bypass or stent?
There are many scientific studies which focus on this subject. The decision on selection of bypass or stent is made pursuant to results of these scientific studies and general status of the patient. In a few words, the possibility of bypass is directly proportional to number of obstructed arteries. However, a bypass surgery becomes unnecessary, if the condition is diagnosed at early stage and patency of the obstructed artery can be ensured through stent implantation. However, the borders are not this clear. For example; lungs and kidneys should function well enough to tolerate a bypass surgery.
What is the most frequent mistake done by those who underwent stent placement?
The risk of re-stenosis (obstruction of a blood vessel again) increases due to following mistakes that are done by patients who are placed a stent: recourse to unhealthy life style; weight gain; poor exercise; re-starting smoking; elevating cholesterol; or using medications irregularly.
What is the rate of re-stenosis in patients with history of stent placement?
Approximately 50% of the vessels bypasses using a vein of legs obstruct 10 years later. The risk of stenosis is 20-25 %, if intrathoracic grafts are used for the bypass surgery. The risk of re-stenosis is 10% for in drug eluting stents approximately 3 years after the surgery.
Does second or third intervention increase the morbidity in patients who are undergone a surgery or stent placement once?
Unhealthy life style and treatment incompliance may cause re-stenosis of an artery. The re-stenosis is even more likely in group of patients with high genetic risk. In these cases, a redo by-pass surgery or stent placement may become necessary. Every new intervention and surgery increases the risk.
How about the common belief “heart diseases are more common and the prognosis is poorer in mean”? In this case, what should women do about this?
While cardiovascular diseases are more prevalent in men, the period after a cardiac arrest or stenosis is worse and poses more risks for women. Women should exercise more, try to prevent weight gain and fat accumulation especially after menopause and have their cardiovascular risks checked up at regular intervals.
Why is it important to be careful about medication use? Are herbal medications used in the treatment?
A person with history of bypass surgery or stent placement should necessarily use blood thinners and cholesterol lowering drugs. They should be very careful about the common misinformation about cholesterol lowering drugs. It is more accurate to obtain professional advice and treatment service from scientific institutions and hospitals rather than the media. Attempts to cure these patients with herbal remedies are among the most common mistakes don in Turkey in the 21st century. It is strictly necessary to avoid those treatments that have no scientific grounds and especially those people who are not licensed and competent to manage this condition.
