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Is Bypass Truly Better than Stenting?
Date:2/18/2009

ent vs. 0.6 percent in the PCI group.

But the finding gives people who want to avoid surgery a viable option, "if they accept the possible need for more future procedures," Holmes said.

Until now, "patients in a study like this would have been told that the treatment of choice was bypass surgery, and there wasn't any good data to make a decision because it hadn't been studied in any rigorous way," he said. "This study looks at the most complex group of patients with the most extensive disease that has ever been looked at."

With the study results in hand, Holmes said, "the physician can present the data, but the patient is the one who can make the choice."

That's a course that many physicians might choose, said Dr. L. David Hillis, chairman of the department of medicine at the University of Texas Health Science Center in San Antonio, and co-author of the editorial.

"I think it's dealer's choice," he said. "I present the patient with two options. Some choose one, and some choose the other."

Some people are so fearful of the possible problems of bypass surgery that they will choose the stenting procedure despite the increased chance that they might need a second procedure in the year ahead, Hillis said. Others will opt for the certainty of surgery.

However, there are cases in which the decision has to be made by the doctor, he said. People who are unable or unwilling to take the clot-preventing medications, such as aspirin or Plavix, would not be suitable for stenting and "should be strongly encouraged to have surgery," Hillis said. "Then there are patients who for some reason have another disease entity that makes surgery a risk -- a bad lung condition, for example." Such conditions are found in 5 to 10 percent of cases, he said.

But generally, Hillis said, many physicians will let the patient choose. "I haven't taken a poll, but I think most would sit down and present the options to the p
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