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Student Research Guide: Drug-eluting stents vs. Coronary Artery Bypass Grafting: Home

by Nicole Branam

Introduction to the Topic

Is having a drug-eluting stent inserted into the left main coronary artery a better alternative to unblock an artery than going through a coronary artery bypass grafting surgery for a long-term solution?

My topic is about blockage in the left main coronary artery, also known as the "widow maker". This artery is in the front of your heart and is the most dangerous place to get a blocked artery. From my research I found only two treatments being tested to see how the heart does after a period of time. Each checkup could be from 1-7 years. It all depended on what study was being conducted. The two treatments for a blockage in the LMCA is a coronary artery bypass grafting surgery or a drug-eluting stent. I wanted to know which treatment is better for the long haul. My finds have brought me to have my thesis saying that, due to its low mortality rate and positive outcomes, a coronary artery bypass surgery is a more effective solution to treat unprotected left main coronary artery disease than inserting a drug-eluting stent, in the obstructed artery, for a long period of time.

A drug-eluting stent is a type of coronary stent, or percutaneous coronary intervention (PCI), that helps blood flow easily when an artery is narrowed or blocked because of plaque deposits that build up over time. The DES is tube like that is made of metal with a mesh looking design. The stent is coated with a drug, either sirolimus, paclitaxel, everolimus, or zotarolimus, located on the outside of the stent. Once insertion is completed, the drug is gradually released into the arteries walls to help prevent the artery from reclosing due to more plaque build-up. Stents are either inserted through the femoral artery in the upper thigh or the radial artery in the forearm using a balloon catheter. The catheter is guided by the cardiologist that is performing the procedure through blood vessels until it reaches the blocked coronary artery. Then the catheter is expanded slowly to widen the artery. Once the artery us wide enough for the stent to be placed and stays there, the catheter is deflated and taken out leaving the stent behind leaving the artery open. 

Coronary artery bypass grafting surgery occurs when a narrowing of an artery occurs, cardiologists take a healthy artery from a different location in the patient’s body and attach it to the blocked problem artery to create a new path for blood to flow throughout the heart. A CABG procedure is considered open-heart surgery. Prior to coronary stents being invented, CABG procedure would be the go-to treatment for ULMCA and other blocked arteries. However, since stents became public, CABG is used mostly for severe heart disease conditions, like a blockage in the left main coronary artery. Like all open-heart surgeries, the CABG treatment has its own risks and/or complications. So many patients that can make the decision of which treatment they want to take will consider going through a CABG procedure as a last resort. 

Keywords for searching the topic

Keywords that worked for my topic were:

  • CABG
  • DES
  • alternative
  • drug-eluting stents
  • stents
  • etc.

Best Databases/Search Engines

The best databases that worked for me was the

  • Credo Reference Database
  • Academic Search Complete
  • Google using Site:.edu, .gov
  • Fact on File: Issues and Controversies 
  • Pros/Cons

Start Your Research Here

Ali, L., Malik, S., Khalid, A. B., Sultan, M., & Sadiq, N. (2014). Safety and Technical Success of Percutaneous Left Main Coronary Artery Stenting. Pakistan Journal of Medical Sciences, 30(4). https://doi.org/10.12669/pjms.304.4859

  •     This article is about deciding if having a percutaneous coronary intervention (PCI) stent inserted into the left main coronary artery (LMCA) is safe and what the positive rate of success are. This article was chosen because of how it describes how effective a stent in the LMCA can be as an alternative to the coronary artery bypass grafting (CABG) procedure. Introducing a new factor in treating a heart condition can evolve the medical heart science and treatment methods. The result was that the PCI stent is acceptable and explains that the short-term safety of the procedure is acceptable but does not have enough data to research the long-term safety and effectiveness of the treatment. This article provides an approach to an unknown treatment for a blockage in the LMCA and gives a new perspective to treating patients with an alternative to a CABG procedure. 

Cardiovascular disease. (2021). In Encyclopedia Britannica. Retrieved from https://academic-eb-com.skagit.idm.oclc.org/levels/collegiate/article/cardiovascular-disease/106245

  • This article is about the heart muscle’s function, arteries, diseases, and treatments for the different diseases. This article was chosen for the background information about the different arteries the heart has and the diseases that can occur in the heart. There are mentions of the arteries and their treatments for diseases that occurred was the type of information that caught my attention. The article gives information about open heart surgery that corresponds with CABG procedures. The article section with the artery diseases has images that mimic the types of problems that can occur in the artery that helped with my understanding of my topic.

Kajimoto, K., Miyauchi, K., Yamamoto, T., Daida, H., & Amano, A. (2012). Meta-analysis of Randomized Controlled Trials on the Treatment of Unprotected Left Main Coronary Artery Disease: One-Year Outcomes with Coronary Artery Bypass Grafting Versus Percutaneous Coronary Artery Intervention with Drug-Eluting Stent. Journal of Cardiac Surgery, 27(2), 152–157. https://doi.org/10.1111/j.1540-8191.2011.01410.x

  •     Talks about the one-year outcomes of CABG surgery and a drug eluting stent. Talks about the positive outcomes of drug-eluting stents through randomized trials. The trials are of patients that have LMCA disease and was put through the CABG procedure or through the drug-eluting stent procedure. Coincided with my topic. There were many limitations that occurred. Comparison of drug-eluting stents and CABG said that CABG is the better procedure to go through to treat heart disease. 
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