A recent multinational study led by Stanford Medicine researchers has revealed that modern stenting procedures rival bypass surgery in preventing major complications. The study compared the risks of death and stroke after both procedures, finding them to be similar. Notably, the risk of heart attacks was only mildly increased following a stenting procedure. Historically, research suggested bypass surgery often led to better outcomes.
“This is the first study to consider contemporary approaches when comparing the two procedures, and it gives us a big, much-needed update,” William Fearon, MD, professor of cardiovascular medicine and the trial’s principal investigator, stated.
The trial was conducted across 48 sites and monitored hundreds of patients over five years. The results were published in The Lancet. Frederick Zimmermann, MD, and Nico Pijls, MD, PhD, of Catharina Hospital in the Netherlands, contributed as co-authors.
The study details that during bypass surgery, doctors create a new path for blood flow by using vessels from other body parts. Stenting involves widening existing paths with expandable mesh tubes. While bypass is a major surgery requiring extensive recovery, stenting is typically an outpatient procedure.
Despite past studies favoring bypass for long-term success, the new data indicates both procedures are almost equally effective for treating three-coronary artery blockages. Fearon commented, “We saw no difference in your risk of dying, even five years out. That’s an important change since previous studies.”
However, stents are more likely to require a follow-up procedure, needed in 15.6% of stenting cases compared to 7.8% for bypass surgeries. Yet, Fearon noted that subsequent stenting remains minimally invasive.
The evolving results are primarily due to advancements in stenting technology and techniques. New stent designs, now more flexible and effective in drug delivery, have improved outcomes. Additionally, the trial employed a method known as fractional flow reserve (FFR), which guided the necessity for stenting more accurately than past reliance on angiograms alone.
“The approach that was taken with this study is one that really embodies the idea of precision medicine,” Fearon said. Despite these advancements, patients with numerous blockages or diabetes might still prefer a bypass. “This is the kind of information you need to make the best possible decision for each case.”
The study received funding from Medtronic Inc. and Abbott Vascular Inc., but these entities were not involved in the study’s planning or execution. Researchers from various global institutions also contributed to this work.
For more information, contact Lisa Kim at Stanford University.
