Bypass surgery after a stent?

Ask the doctor

Q. If I have a stent, can I have bypass surgery in the future? What about the opposite scenario—is it possible to get a stent after having bypass surgery?

A. In a busy cardiac catheterization lab, both of these situations come up not infrequently. The short answer to both questions is yes.

A stent is a tiny wire-mesh scaffold that holds open an artery after an angioplasty procedure clears it of a blockage. That's done by passing a narrow tube through an artery in the upper thigh or the wrist and maneuvering it up to the heart. During a bypass, a surgeon takes blood vessels from other parts of the body (known as grafts) and uses them to reroute blood flow around a clogged heart artery.

After a stent placement, a future bypass of the same coronary artery is usually possible if the stent plugs up or a new blockage forms. The surgeon might not be able to sew the graft into where the stent lies, but the graft could likely be placed in another part of the artery.

After a bypass, the graft may narrow or close up over time. And it's not uncommon for bypass recipients to develop narrowings in other arteries. Both problems can be treated with stents. But neither a stent nor bypass surgery stops atherosclerosis, the disease process that clogs coronary arteries in the first place. For this reason, anyone who's had either procedure ought to remain under the care of a cardiologist for the rest of his or her life.

— Deepak Bhatt, MD, MPH
Editor in Chief, Harvard Heart Letter