Stem disease: Treatment with stent or surgery?

It is of particular clinical importance, because it irrigates to a very large extent the myocardium of the left ventricle. Therefore, severe stenosis of the trunk carries a high cardiovascular risk, especially if it is not treated correctly and in time.

Nowadays, the treatment of stem disease can be done in two ways, either with the percutaneous method – that is, angioplasty with stent implantation, or with open surgery, the bypass (aortocoronary bypass).

“The evolution of interventional cardiology, over the last 40 years, has been rapid and has helped to successfully treat, with the percutaneous method, more and more complex cases. This method is carried out from the wrist, where through the carotid artery we insert catheters, which reach the vessels of the heart, using local anesthesia.

Then, with special materials such as wires, special bags and stents, we can achieve the total opening of the vessel and restore the damage to the vessels of the heart (coronary arteries).

With the development of new techniques and the use of the 3rd generation drug-coated stents, encouraging results were observed, making angioplasty one of the methods of choice in the treatment of left coronary artery trunk”, points out Mr. Thanos Kolyviras, Interventional Cardiologist, Director 4 Cardiology Clinic – Interventional Cardiology Clinic at Metropolitan General.

In contrast to open surgery – bypass, percutaneous treatment with angioplasty offers several advantages to patients. The operation is performed from the wrist, without open incisions, takes one to two hours and most patients can go home the same or the next day after the operation with the recovery time being significantly shorter.

“Open” heart surgery is performed with the aim of creating bypass routes for the blood (which will bypass the narrowing of the arteries of the heart) for the purpose of its proper circulation within the coronary vessels.
Grafts from the patient themselves, such as part of a leg vein (saphenous vein), one or two arteries from the chest (internal mammary artery) and an arm artery (carotid artery), are used to make bypassing strictures. The hospital stay is usually 6 days (including the Intensive Care Unit stay).

There have also been significant developments in the field of cardiac surgery in recent years, where operations can now be performed without the extracorporeal circulation machine (off-pump bypass), as well as the chest incisions are smaller with the use of robotic means.
At a scientific level, the studies that stood out in the last 5 years are NOBLE and EXCEL. Two very important studies, which wanted to answer the question of which method is safer between stent angioplasty and bypass and which of the two offers better long-term results.

“In many scientific conferences there was a dichotomy between interventional cardiologists and cardiac surgeons, as the EXCEL study showed superiority of angioplasty over bypass, while the NOBLE study showed the opposite.

We conclude that both reperfusion methods (percutaneous angioplasty with stent or bypass) are safe for the treatment of patients with stem disease and these operations should be performed in specialized centers.

The 4th Cardiology Clinic – Interventional Cardiology Clinic of Metropolitan General consists of specialized interventional cardiologists who undertake the early diagnosis, treatment and interventional treatment of patients with complex coronary artery disease and stem disease”, concludes Mr. Kolyviras.

Written by:

K. Thanos Kolyviras, Interventional Cardiologist,

Director of the 4th Cardiology Clinic – Interventional Cardiology Clinic at Metropolitan General

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