Hi all
I have been diagnosed with blockages to 3 arteries and the consultant has given me the option of a bypass or stens. Almost a 50:50.
I am unsure which to take and was wondering if anyone had been in the same boat and had any advice. Which you chose and why ?
I’m sorry I can‘t offer any advice, but there are others who have experienced both. I just wanted to wish you good luck with whichever procedure you decide to go with!
I hope others will be along soon.
All the best.
Tos
Thanks
I would ask the cardiologist what are the pros and cons of either in your particular situation. The doctor must understand all the factors which relate to you and the operation.
Then it's up to you. One thing which is clear, a bypass is a much bigger deal than the angioplasty you would have to insert stents.
Also it's unlikely to be the same person who would put stents in to the surgeon who would do the bypass. I assume that the 2 people would have arrived at this conclusion, but it might be worth asking.
Hello and welcome to the forum!
They originally said stents after my angiogram revealed four severely blocked arteries. After further tests they decided on bypass surgery as it would have required excessive tenting.
You don't say if you smoke. If anyone intends to resume smoking after surgery then it's stents as on average veins acting as arteries will suffer restenosis much faster.
I am surprised your surgeon hasn't got a preferred option.
Thanks for the reply. I don’t smoke at all and the consultant I have seen is a specialist in stens. I have also a “moderate” impairment of the valve and with 3 blockages. So he discussed my case with a surgeon who indicated the triple bypass.
It’s really confusing and I suppose I’m after others experiences while I make a decision.
Would the intention be to repair/replace the valve at the same time?
HiBubbler,the reason the surgeon might be wanting to do stents is that he is good at doing them.I’ve just had my valve replaced by open heart surgery and they would have done bypasses at the same time if I needed them.If you are nearly at the severe stage with the valve it would be better to get them done together.You are going to need the big operation anyway in the future for the valve.That needs to be discussed with the cardiologist.
I was diagnosed with severe heart failure and was prioritised for angioplasty (stents). Had two put in and they then discovered a regurgitating aortic valve so AVR was carried out. As part of the procedure, as insurance for the future, they did a single CABG.
The stents gave me an instant uplift in the way I felt. The AVR & CABG have also lifted me but, as one would expect, healing takes a lot longer and it is more uncomfortable. I've been lucky in that I've not had any bad pain.
You don't say how old or how active you are but if recovery time is important to you, unless advised otherwise, I'd go for the stents unless they advise you that something needs to be done about the valve where there is little choice unless you are frail when they'll do a TAVR.
Thank you for the reply.
Good advice.
Hello 
I have had a triple Bypass stents were not an option
It does not really help when they are saying 50/50 to both
Stents are less invasive with a quicker recovery but after I read up I think even though it is a bigger operation and a longer recovery I was glad I had not been given a choice and just told what was needed
With this one I would suggest you do your research talk again with the Consultant if you can , family , friends and I hope you will be able to come to the right decision for you
Let us know what you decide and how you get on x
It's extremely rare for the patient to be given the choice. I had bypass surgery and the results were absolutely transformational in that I feel ten or twenty years younger. However, I'm under no illusions, open heart surgery is a serious procedure with serious risks, and there are people on this forum who bitterly regret their bypass operation.
Consequently if I had a choice I'd go for stents first. If they didn't work only then go for a bypass.
The other thing is that bypass grafts don't last for ever. Despite a guy on this forum having grafts that have lasted incredibly well, something like thirty plus years which has put him in the Guiness Book Of Records, for most people fifteen to twenty years is about as long as grafts last without another intervention. You don't give your age, but the younger you are then the stronger the "stents first" argument simply on the basis of how long bypass grafts would last.
A final point, neither stents nor bypass surgery actually "cures" us. We'll still have heart disease and it will only keep advancing. What stents and bypass surgery can do however is buy us some time for medication and life style changes to slow down the progress of our heart disease, ideally to a virtual crawl.
So whatever you choose be prepared to make fundamental life style changes and to be very diligent about taking your medication.
Good luck!
Thanks that’s helpful
Stents do not last forever either my husband needed restenting after 14 years as the stents were no longer working for him and he had 99% stenosis where they were. The consultant said that stents do not last that much longer than about the 14 year mark. My husband was only 47 years old when he had his first heart attack and stented first time.
Just from my own experience, I started with 2 stents, then when I needed another angiogram, was told that bypass was a better option. But unfortunately, the cardiologist was overruled. Since that time, I've had constant problems, a few more stents. My sister had triple bypass and never had any more problems. So 7 angiograms and 5 stents later, I'm no better off. It is totally your decision, and I'm not saying that bypass is easy, but neither is being constantly needing stents. By the way, I have good cholesterol, around 3, but I continue to clot. Diabetes is main problem and other health issues, on 22 medications a day. Take care. Moni
My son has one stent and went through a angiogram a couple days ago and has another artery that is 100% blocked and was told if you have too many stents you then cannot ever have a bypass. Ask your cardiologist about that
I would ask them which would give you the best out come. I was not given the choice even though I was pushing for stents (I was 50). My consultant said their recommendations was based on what would give me the best out come,
I would also ask why they are giving you the choice rather than advising you.
Hi Bubbler99
I think its unfair they have given this decision to you. You need their professional opinion of which is best in your case.
Do you have diabetes? I have type 2 and was told I couldn't have stents as they wouldn't last more than a year or two so I went through triple bypass sugery (was meant to be quadruple but they couldn't find a suitable 4th graft artery to use) Unfortunately my grafts all failed so ended up having 4 stents after all.
Personally I would ask the question if you start with stents and they fail in the future would I still be suitable for bypass. That's the normal way round it's done. My case is very unusual and I wish I'd had stents to start with.
Let us know how you get on
All the best
Susie
hi bub, I am sorry to hear about your results. If you have not experienced any Heart Attack ( MI) , other heart problems & don't have diabetes in that case I would strongly suggest to give stents a try first & leave by pass for any eventuality in future. Workable Non invasive options are always preferable & first choice in non emergency situations. I am a bit amazed as cardiologist always brief patient & family in detail on options & best way forward.
Doctors can always perform by pass subsequently if stents don't work properly ( which is very rare).
Rest is up to you and your doctors.
Good luck 👍🏻
personally I would go for the stents because heart grafts don’t last too long my dad had it done and got around eleven years before he was back to suffering with angina and heart attacks again at least if you have the stents and all goes great even if after another 10 years or more if u have any problems then the bypass would be plan b if u go for the bypass to start with then if it last 14 years to have that major operation again at a older age makes the risk greater so stents for me first but do what you think is best for you I went for the stent option so I still have a option left open for me in the future and as other people have said the recovery time is much quicker with stents and I felt relief after a few days after good luck whatever u decide
Stents as a first choice. The technology is very advanced. The procedure far less invasive. The recovery far quicker. A bypass is major surgery requiring 3+ months recovery and is painful. Bypass grafts are usually veins and they can fail - if they do then, you’re probably back to stenting in any case. Whereas if stents fail then a CABG remains an option. I had a CABG x4 in 2017 using 3 saphenous veins. All 3 had occluded by June of this year, resulting in 2 PCIs (one in an emergency) and 6 stents. I was lucky, I had private insurance and could turn to a top stenting cardiologist - Dr Suk Nijjer at One Heart Clinic in London. He is a leader in PCIs including rotational atherectomy for calcified plaques. Also see if your cardiologist will use an intravascular ultrasound (IVUS) which allows the surgeon to see inside the artery when sizing, placing and fixing the stent. Apparently it materially improves the outcome. I believe the world record for stents is 34 so don’t worry.
I have had a similar experience. Quad CABG in August 2015. Three of the grafts failed by Late March 2016. The only graft which survived was the mammary arterial one. The others were veins harvested from one leg and one arm. I was in Austria and they inserted 8 stents in my original arteries. I was under the understanding that was the only option. I’m now 74, and keep pretty well. Can occasionally get a little breathless on steep slopes, but still pretty active.
We are all different, as are our individual conditions, but if I had my time again, I would go for stents first. They could be sufficient for a long time.
Iv had numerous stents and a quadruple bypass if you have the choice try the stents first definitely less after affects x
I had 99% blockage but luckily my heart had made natural collateral bypasses. I now have 3 stents in my LAD and a 4th in another artery. It's been almost 6 years now and I just had a heart catheter, Dr. said it looks like he just put them in so it's so far so good! I was in the same situation where the ultimate decision was up to me. My reasoning at the time was that I believed there would be advancements in medicine that would eventually replace both bypass and stents I could buy myself some time. Hope this helps. I'm from the USA in Tennessee, came across this site years ago by accident but it's been a great source of support and information. Good luck to you I know you'll be fine whatever you decide!
My husband's blockages were on a bend so they couldn't use stents so a quadruple bypass was the best option for him. He had it done in 2000 and he has been fine since. I would be talking it out with another cardiologist if possible as it is a big decision to make. Best wishes.
Hai Blubber99,
See:
1)
med.stanford.edu/news/all-n....
2)
health.harvard.edu/heart-he...
(1 and 2 are the notes below in the BING-chat)
BING-chat:
Hello, this is Bing. I found some information that may help you compare bypass surgery and stent to treat heart disease.
According to a study by Stanford Medicine, bypass surgery generally had better outcomes than stent for people with severe coronary artery disease (CAD), but some people with less complex disease may benefit more from stent1. Another source also suggests that bypass surgery is superior to stent for people with diabetes or heart failure2.
However, the best treatment option depends on your individual condition and preferences. You should consult your doctor before making any decision.
Here are some links that may be useful:
- Should You Have Bypass Surgery or a Stent to Treat Heart Disease?
- For severe heart disease, bypass surgery slightly better than stenting — with caveats, study finds
- Stents vs. Bypass Surgery: Which Is Better?
- Bypass or angioplasty with stenting: How do you choose?
Berst wishes,
Henk
Morning Bubbler; I was. 52 when after an angiography I had a Ball in inserted (Dr Ramsdale,Cardiothorac centre Liverpool) into my artery (baloon, not ball) to open up my artery, he decided not to use a stent. I am now in my mid 80's ( non smoker) and ok except for slight Angina which I medicate for. All my friends who were heavy smokers have Long gone,deceased. I was told my artery would probably narrow in 10 years. I cut down completely on all food/drink that causes cholesterol and eat porridge that naturally clears arteries.Also their is a link between hard and soft water, think it's the soft one(lime) which builds up in your arteries. Well good luck. Wenlock.
I had same problem and advised triple bypass that was 10 years ago and never looked back
I am four weeks post op, triple bypass. I have to say, everything has gone smoothly. Apart from moderate soreness and disrupted sleep, it’s not been a drama. I couldn’t have stents. Arteries were too buggered. Which I was gutted about. I thought having a stent was the best plan, and CABG was second fiddle. But I’ve spoken to a lot of people, there’s more pros to the cons of having a CABG. Good luck.
Thanks a lot I’m glad it’s working out well for you.
Dear Bubbler,
In ignorance of your condition I can only say that I had 3 stents 20 years ago, when I was 68, and that they are still functioning well. So, in ignorance of your condition I can only say that this has been a very satisfactory and life-enhancing outcome for me
warm best,
Tavistuck
I had a heart bypass 18 months ago and feel absolutely fantastic now, minimal meds and can exercise as much as I want and hard as I want.I had no other conditions and was pretty fit. It's personal choice ultimately
HiI had this conversation whilst lying on the table in Theatre after my angiogram. I'm an active and healthy 64year old ex Nurse. Never smoked .
The cardiologist said my CAD was quite severe and I would require too many stents and a triple bypass was the best option. An MRI showed I had experienced at least two strokes and I also had some heart lesions.
My carotid arteries were 90% blocked and I had pain frequently in my neck.
My Father had stents which later made no difference and he subsequently had a large heart attack and had brain damage and required nursing care for 8 remaining years.
I am currently on a waiting list for surgery but in addition to taking prescribed meds, I have stopped drinking alcohol..cut carbs..lost weight and take a shot each morning of a half tsp of cayenne pepper. This is a natural vaso dilator.
My neck pain has gone...and I feel much better.
I presently am evaluating my situation and feel that I would prefer to maintain the medication and lifestyle protocols and preserve the quality of my remaining years.
In my opinion it's a very individual choice and I hope my rather long account gives you another perspective.
TC
Jane
My Uncle had a triple bypass , then some years later his arteries narrowed and he received stents.After the triple he managed to get back to being a professional football referee . He was retired from the game by the time he needed stents after having another minor HA a couple of years ago . The initial operation had done him well for over 22 years , he got a second wind after the stents and is back to playing golf ( with as he says a dodgy swing) and umpiring cricket in the season.
My Mum was told to try the stent choice because of other health issues , she had COPD so major surgery had more chance of complications. Unfortunately, at the time no one in our family had been tested for the genetic illness that us the root cause of all of our evils, Ehlers Danlos Syndrome.
That's a connective tissue Disorder that effects collagen production in the body and makes any body part containing connective tissue too stretchy and lax.
For my Mum the sagging vessels and heart tissue had been caused by EDS and that was the root of the heart problem.
In theory, the stents should have mended that but unfortunately the elasticity in the blood vessels meant that they could not fit them and get them to remain safely in place even after three attempts,
Unfortunately, that caused delays over her heart condition being treated over a number of years.
Basically, the choice between the two and how well they work is very individual and your whole health history needs consideration when you make a decision.
I'm surprised they are giving the final decision to you in this way.
I think you do need to ask them some specific questions , even via email or phone appointment if you can.
Ask why the choice between each procedure is 50:50 in your particular case?
Ask if there are any particular health reasons , such as other health issues you might have , that mean they are 50:50 to which is the better option?
And ask if the choice between the two options is because there are delays in getting one operation rather than another?
( As sometimes they may prefer to give you one surgery rather than another but consider that you could still benefit from the angioplasty and stents because you can get a date for it quicker even though a bypass may be the more successful option for you)
Even ask them which they would have themselves based on your charts if the choice was there's.
Also consider your other health conditions, if you have any, and what effect they might have on the success of stents over bypass , or on how quickly you may be able to recover from a surgery afterwards.
I feel for you . When you are worried enough the last thing you need us to feel confused by the information you are getting about such an important decision.
Let us know what you decide and how things go , take care , Bee
Thanks for your support you hit the nail on the head!
Hi, Bubbler99,
I am sorry to hear about your blockages, but soon, you should start to feel much better. It is sometimes amazing what modern medicine can do to improve our health.
I do not have any personal information to offer regarding your choices, but it is fortunate that you do have this time available to think about the choices, gather information from others, talk with your doctor and family, etc. That can all be a blessing.
I will share the story of my ex-husband for your consideration. In 2006, he had gone to a cardiologist as a referral from our GP for a heart stress test. He was walking on the treadmill and all was going fine. I left the room briefly to go to the bathroom, and when I returned, my husband was lying on a table with the doctor and a nurse working over him. He had collapsed due to a blockage in a main artery.
We were told that he needed a stent, and he was scheduled for surgery within two days. Long story short, my husband was awake during the surgery. His cardiologist ended up seeing six blockages that required some “fix.” He asked my husband then and there (lying on the operating table) whether he wanted six stents placed, or wanted open heart surgery. My husband was on medication, in the middle of a procedure, and he had to decide while lying there. That is why I said that you are lucky to have some time to carefully weigh your choices.
My husband chose the six stents. Because of the strong contrast dye used, the cardiologist completed three stents that first day, let my husband rest in hospital for one day, and completed the remaining three stents the next day. We were both shocked and confused that he had needed six stents, and we just didn’t know what to think about the choice that he had made, the new medications that he had to take and all.
The good news is that my ex-husband made a full recovery and is still strongly kicking 17 years later.
You are going into this knowing that you need at least three stents. You can gather facts and stories and suggestions to help you make the best informed decision for you. Plus, with advances in heart health, I believe that you should have success with which ever choice you make. That is the good news!
I wish you the best in your surgery, whichever you choose! ❤️
Thank you. Good to hear things turn out well.
I'm not sure I can add much to previous answers, or whether any of us can assist you in your dilemma. All of us are different both physically and psychologically. I, like others, am surprised that they have laid this decision at your door without a recommendation.
I've had both. HA end 2019, thrombolysed with drugs, and a stent in RCA a couple of days later. Angioplasty showed substantial stenosis of all arteries at the time, but stenting of the others wasn't possible due to the arteries being too "bendy", or tortuous as they call it. I was put onto the usual drugs, and was OK for 18 months, but then I started to get similar symptoms to when I had the HA. Excruciating jaw pain, unconnected to exertion, and often in the middle of the night. It was unstable angina that was becoming intolerable.
Back to angioplasty, and I knew what the verdict would be. The stent in the RCA was apparently functioning perfectly with healthy flow, but the other 3 would need CABG. They kept me in hospital, and I had the operation 2 weeks later.
For sure it is a much bigger deal than being stented. The stenting was really nothing at all afterwards, but the bypass felt like I'd been hit by a bus for the first few weeks, although I did expect it. That was over 2 years ago, and it has cleared up the "HA symptoms". I don't get the jaw pain anymore, and I'm back to playing badminton. I do get odd niggles, like sporadic palpitations, and a bit of tightness that they insist isn't cardiac, but who knows? Could be connected to the cutting of tissues and nerves during surgery. Had I been able to get the other 3 arteries stented, I would have done so at the time and maybe with the same outcome, but it wasn't an option, and none of us can know how things would pan out in a parallel universe.
I suppose the difficulty in your case could be the suspect valve? They might be thinking that if they do that they could do CABG at the same time. I still think they should give you a professional steer on it though.
Anyway, as I said, I've had both stent and CABG, and I'm still breathing, so I hope that offers some encouragement.
High bubbler I have eight stents now for two years three blown hart valve ten meds a day o and a icd fitted and feel fine I would go with the stent first and if they don’t work you go for the bypass it’s not a one shot deal but it is the easiest two weeks after you will be back to normal
I had bypass surgery 10 years ago as where my blockage was stents were not an option - my blockage was what they call the Widowmaker. My research indicated that stents were not a long term fix so in retrospect I am pleased I had the bypass.it is daunting at the time but now quite a routine operation I believe. The other thing I did was to do lots and lots of reading and changed my diet considerably for the better - basically real food and minimal ultra processed foods.
Hi,
I had exactly the same diagnosis as you with the same options offered, I was 60 at the time & chose the 3 stents so I could get on with my life with a better diet and limited alcohol all good so far 👍🏻
Hi. I suffered a heart attack 5 years ago and as I wasn’t suitable for a bypass because my arteries were too far gone I was given a stent. Given the choice I’d have a bypass
I had a CABG×4 nearly 17 years ago when I was 47. Like some other respondents, I had no choice either. As I understand it, patients tend to prefer stents, because the procedures are less radical and recovery is faster. However stents can't always be correctly positioned and the risk of a shorter-term redo is greater.
So for older patients, stents can actually be preferable.
CABGs can give better longer outcomes (with a lower risk of failure/redo), so may be preferable particularly for younger patients.
So for me, the grief and recovery from a sternotomy (cutting the breastbone and 6-8 weeks of diminishing pain and suffering) has been worth it. Apart from a lifelong prescription to reduce the risk of another acute coronary syndrome (e.g. heart attack or similar) I've been reasonably fit and well. I don't need to take GTN for angina.
If your consultant has given you the choice, I'd ask him (or her) what he/she'd do if he/she were you. Also I'd think about seeking a second opinion (maybe from a cardiothoracic surgeon).
Hope that helps. Good luck, whatever you end up doing.
Cheers,
Fish4Info
Hi bubbler99,
It all depends on your age and other risk factors like location of blocks , number &length of blocks, width of block & are they stentable without CTO .Stent are key hole surgery and bypass full blown surgery. Comparison is like trailer to movie. Stents are generally have far less risk factors in comparison to bypass. If doctors have accessed and evaluated and still want you to make a choice as they think both carry same risks and benefits, stents is the option. Speak to doctor and ask for his opinion. Make a collective decision.
As I read above someone had 99% blockage but luckily his heart had made natural collateral bypasses. This was the same in my case, but only one natural bypass and still two blood vessels almost closed so I had to go for CAGB.
It would be interesting to find the cause of natural bypasses. The heart is a bundle of tiny blood vessels which can enlarge in case of blockages. But unfortunately not reliable or in time.
Hi Bubbler, I've not been on here for ages and have just seen your post.
If it's your first time for anything heart wise, I'd probably go for stents first, but obviously everyone is different. I haven't had CABG but it is now being talked about , along with other options, because I have needed stents unblocked repeatedly in a short space of time. (I'm a bit weird, lots of people are fine with stents ) The bypass surgery sounds more intense to me and a much longer recovery time I think.
But everyone is so different - it's good you are getting a chance to decide your treatment, but I've had that situation a few times, and sometimes I want the medical team to use their expertise in that.
Hope it goes well whichever route you go down : )
Every case and everyone is different. I had the same decision 18 months ago and decided on the stents, they were less invasive, less likely of any complications during the procedure, would not require any anaesthetic, would be up and about with 24 hours, no risk of infection, no scarring, less painful, and to be honest, I would prefer to be awake and aware of what was happening around me. etc. To be honest one of the other reasons was that the statistics which I asked was that I was less likely to die having stents put in than during the bypass.
I had two stents inserted before they found another issue that resulted in my having OHS with an AVR due to the valve suffering from severe regurgitation & CABG as insurance on a third restricted cardiac artery that might be a problem in the future.
If you genuinely have the choice I’d elect for the stents, recovery is easier and quicker.
However it is normally never that simple and you MUST discuss this with you cardiac consultant(s) before making a decision.
After heart attack I had 1 stent and told that further stents would be rquired. 6 months later was informed that a 2x bypass was required. Fifteen months and 2 cancellations later I had the operation. Both the stent and bypass have worked well and I have made a full recovery. Waiting for the bypass was very stressfull and recovery was also much longer.
Hi, you have had some very good responses above which I hoped have helped you. In my case I had a double CABG 3 and a half years ago when I was 46. Stents were not an option. To be honest I was glad the decision was made for me but had I got to choose I think I would have gone for the stents but only after I had discussed the pros and cons to both procedures throughly with the cardiologist. Just to add, one of my bypass grafts actually failed a year after my bypass even though both of my grafts were artories so in the end I also had to have a stent inserted earlier this year to correct that issue. While having angioplasty and a stent inserted was certainly less invasive and a quicker recovery than the CABG it was still something that took a while to recover from.
Good luck with whatever decision you make and fingers crossed for a good outcome.
Hi there After my angiogram at St Thomas hospital I was told I needed a triple heart bypass which I accepted ,when I went to my pre op check up a week before bypass was being done my cardio surgeon said to me you have a choice in what to have ,you can either have medication, stents done or have the triple heart bypass , at my age 52 ,I ask surgeon what he recommended and he said at your age the bypass is better option ,on the day of the op they ended up doing a quadruple heart bypass, surgeon said we thought we give you an extra one as we had you opened up ,that was Sept 14th 2022 ,and I was back plastering in February 2023 ,still get odd bouts of anxiety by am currently having hypnotherapy once every 6 weeks privately which is a great help and comfort
Thanks for the note it’s really helpful
Heart Bypass Scar
Heart bypass
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