25 Questions and Answers
A stent is a procedure in which a blocked artery is widened from the inside with a balloon and kept open with a metal mesh (no surgery required). Bypass surgery, on the other hand, creates a new bridge (route) alongside the blocked artery using a vessel taken from another part of the body (open-heart surgery).
Bypass is generally preferred when multiple arteries (3 or more) are blocked, when there is narrowing in the left main coronary artery, when the artery structure is unsuitable for a stent (heavily calcified or tortuous), or when the patient has diabetes.
In terms of procedural risk, a stent carries lower risk. However, when long-term outcomes and re-blockage risk are considered, bypass can offer a more durable and reliable solution for suitable patients. The decision should be made by a Heart Team (Cardiac Council).
Yes, it can. With drug-eluting stents, the rate has dropped to around 5–10%, but the risk remains. If the patient does not take their medications or continues to smoke, a clot can form inside the stent.
Bypass surgery aims to extend life expectancy. In patients where the internal mammary artery (LIMA) is used, the graft can remain open for 15–20 years. With a healthy lifestyle, patients can live a normal lifespan.
Scientific studies show that bypass surgery is superior to stenting in diabetic patients and those with multi-vessel disease. Bypass reduces the risk of heart attack more effectively in diabetics and extends survival.
It takes an average of 3 to 5 hours. This duration may vary depending on the number of bypasses to be performed and the patient's anatomy.
If no complications arise, stent patients are usually discharged 24 hours after the procedure.
Bypass patients typically remain in hospital for 5 to 7 days after surgery.
For left main coronary artery (LMCA) narrowing — which supplies around 70% of the heart — international guidelines generally recommend bypass surgery. However, if the patient's surgical risk is very high, a stent may be considered.
No. The procedure is performed under local anaesthesia through the groin or wrist. The patient remains awake and does not feel pain inside the vessel. There may be mild discomfort only at the entry site.
The sternum (breastbone) heals in approximately 6 weeks. During this period, the patient should sleep on their back and avoid straining their arms.
It is a stent coated with a special drug that prevents cell proliferation. This drug prevents the artery from narrowing again due to tissue regrowth inside the stent (restenosis).
It is a meeting in which cardiologists and cardiovascular surgeons come together to review the patient's imaging. A joint decision is made on whether the patient should receive a stent, bypass, or medication. This is the most appropriate approach.
Yes. If new narrowings develop in the bypass grafts or the patient's native arteries years later, stents can be placed in those areas.
Age alone is not the deciding criterion. Bypass can be performed in patients over 80 if their overall condition (kidney, lung function) is good. If surgical risk is very high, a stent or medication may be preferred.
Stent patients usually need to take dual antiplatelet therapy for 6–12 months to prevent clot formation inside the stent. After bypass, a single blood thinner is generally sufficient.
No. Once the recovery period (4–6 weeks) is complete and the patient feels physically comfortable with exertion, sexual activity can be resumed.
Bypass appears more expensive upfront. However, considering the possibility of stent re-blockage and repeat procedures, costs may balance out in the long term.
Yes. Today, stent procedures are frequently performed through the radial artery (wrist) to increase comfort and reduce the risk of bleeding.
Yes. Completely blocked arteries, known as Chronic Total Occlusions (CTO), can be opened using specialised wires and techniques and a stent can be placed. However, the success rate is lower than for ordinary narrowings and the procedure takes longer.
No. With the "Beating Heart Bypass (Off-Pump)" technique, bypass can be performed without stopping the heart by stabilising only the vessel area being worked on.
Almost all modern stents placed today are MRI-compatible. However, doctor approval should be obtained within the first 6–8 weeks after the procedure.
Desk workers can return after 4–6 weeks; those in physically demanding jobs after 2–3 months. Stent patients can typically return to work within 1 week.
In patients with multi-vessel disease and diabetes, bypass surgery — especially when the internal mammary artery (LIMA) is used — offers more durable long-term results and a lower risk of repeat intervention compared to stenting.
