Is bypass surgery better than stenting?

[Shuckapeafarms]

I was diagnosed in July 2005 with CAD. I had a catherization which showed four blockages that included a 95% LAD, 80% LAD branch, and 2 60% Circumflex. The 95% LAD was stented, the 80% could not be stented, nor were the two circumflex stented.
In November 2008 I suffered a mild heart attack. Again I was catherized which now showed 95% blockage in the Circumflex, 95% Coronary, two other blockages with one in the coronary and the other in the circumflex. The two 95% blockages were stented. One of the other two required stenting but was left unstented so to allow for scheduled neck surgery.
While hospitalized for the heart attack my cath site began to bleed more than anticipated. The nurse summoned for a doctor who happened to be one from the cardiac surgery team. While dealing with my bleeding and I assume after reading my chart, the doctor asked me why I was fooloing around with the stents instead of getting the problem corrected properly with bypass? My general cardiologist had told me in the pass if we find more than 3 blockages you are off to the OR for bypass. However, that has never been the case for me. When I confronted him with my latest development and the surgical doctors suggestion my cardiologist replied
"It just depends on whether you ask a cardiologist or a cardiac surgeon what you need"! I find that answer to be appauling and have since changed cardiologist! It gave me the impression money speaks over life and health!
Getting to my question, is bypass the best route to go and if so, can a bypassed vessel be bypassed again and again as required? My previous cardiologist told me a bypass is a one shot deal while stents can be restented. My uncle had three bypass surgeries over 20 years but I do not know if they were on the same or different vessels.
Thank you very much for any insight you may lend. I'm not sure whether to continue with a cardiologist or see a cardiac surgeon. My concern is my health and longevity and not the cost or who can make the most money off my dilemna!

[John Kenyon, CNA]

Hello -

First, in absolute terms CABG is preferable to stenting, since if the patient is prone to restenosis he will have that happen in either case, and a CABG can be stented or re-bypassed depending upon what seems more appropriate to an individual patient at a given moment. However, I have to agree with you the comment made by the first cardiologist regarding it depending upon whether you ask a cardiologist or a CT surgeon was not any kind of an answer and is very misleading.

While stents work fine for some people, it is generally true that three or more vessels at 50-70&% stenosis (depending on the standard of a given center or doctor) will be bypassed, there are doctors (no doubt like your cynical cardiologist) who would rather perform as many PTCAs as possible. This isn't necessarily a favor to the patient.

Much of the ability to re-bypass a previously bypassed artery depends upon anatomy, as there is a huge variation in how these things develop from birth. Some people can be re-bypassed multiple times while a very few have anomalous arteries that can't be bypassed or stented, but even then usually there is the potential to "get" most of them done, and the remaining one has a better chance, then, of developing collateral bloodflow (making its own bypass, in essence).

So I would concur with the CT surgeon who questioned why you were having so many stenting procedures. Eventually this becomes self-defeating. And again, in absolute terms, CABG is definitely superior to stenting, all other things being equal in the equation (multi-vessel disease, repeat restenosis, etc.). I'd at least look into it.

Hope this is helpful. Best of luck to you with this. Please follow up with us as needed.