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Coronary bypasses less common: use of catheters to clear clogged vessels drops only slightly.

Think of it as bypassing the bypass. U.S. heart patients have been less likely in the past decade to undergo surgery to install a substitute vessel around a clogged coronary artery, with many patients instead getting a less invasive alternative procedure.

Coronary bypass operations decreased by 38 percent per capita in U.S. adults between 2001 and 2008, researchers report in the May 4 Journal of the American Medical Association. Meanwhile, angioplasties--in which a doctor threads a catheter to the heart to open a blockage using a balloon--have stayed nearly constant, with the per capita rate dipping only 4 percent over that time. Angioplasties nearly always deliver a coated mesh cylinder called a stent, which props open the vessel from the inside. The study's authors analyzed a national sample of thousands of coronary fixes.

The findings reflect changes since specially coated stents gained U.S. regulatory approval in 2003, says study coauthor Peter Groeneveld, an internist at the University of Pennsylvania School of Medicine and the Philadelphia Veterans Affairs Medical Center. Coatings have made stents less prone to clogging. The new data show the number of stenting procedures in 2008 exceeding bypass operations by 3-to-1, Groeneveld says.

The original guidelines for stents recommended the procedure for people with one or two vessels blocked and neither occluding the left main branch of the coronary artery. But in the past decade, doctors have installed stents in thousands of people with three or more blocked vessels or a blocked left main coronary artery.

In 2009, a U.S.-European team compared stenting and bypass surgery in severe cases and reported that 13.5 percent of patients with stents needed surgery for another blockage within a year. Only 5.9 percent of those getting coronary bypass surgery did. But another look at the same patients, in the March 17 New England Journal of Medicine, found that percentages of the patients free of chest pain at 12 months post-procedure were practically the same in the stent and bypass groups--72 to 76 percent.

"There are quality-of-life issues that are relevant to patients," says Harold Dauerman, an interventional cardiologist at the University of Vermont. "Many patients prefer shorter hospitalization."

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Title Annotation:Body & Brain
Author:Seppa, Nathan
Publication:Science News
Article Type:Report
Geographic Code:1USA
Date:Jun 4, 2011
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