Comparing Coronary Artery Disease Treatments: Stent vs. Angioplasty

This report investigates the effectiveness of different treatments for coronary artery disease (CAD), a major cause of global mortality. The study compares two primary treatments: coronary stent replacement and balloon angioplasty. Through a qualitative study, the research analyzes the outcomes of both procedures, focusing on factors like restenosis rates, complications, and patient recovery. The findings suggest that stent replacement generally demonstrates a higher success rate and reduced restenosis compared to balloon angioplasty, particularly in older patients. The report highlights that while both treatments are safe, stent replacement offers advantages in maintaining open arteries and preventing re-blockage, leading to a quicker return to work for patients. The study emphasizes the importance of thorough clinical assessment and, in many cases, the use of combined surgical approaches to effectively manage CAD and improve patient outcomes. The report concludes by underscoring the need for further research, such as randomized controlled trials, to validate these findings and address the limitations of the current study.

Running head: RESEARCH PAPER
Topic: Coronary artery disease
Name of the Student
Name of the University
Author Note

Abstract:
CVDS are one of the leading cause of death worldwide. An estimated 17.9 million people
died from CVDs in 2016, which respecting 31% of the global death, especially because of the
coronary heart disease. Approximately, 610,000 people die of heart disease in the United States
every year–that's 1 in every 4 deaths (Gerhard-Herman et al., 2017). Out of the 17 million
premature deaths are non-communicable diseases in 2015, 80% are in low- and middle-income
countries, and 37% are caused by CVDs (Stewart et al., 2016). Hence, it is crucial to identify the
best suitable treatment for cardiovascular disease, especially for coronary artery disease. More
specifically, it is crucial to identify which is the best treatment for coronary artery disease,
especially what is the success rate of two suitable treatment. The topic has been chosen because
the very little study has been conducted which undertaken the comparison between two potential
treatment procedures. Hence, this paper recommended the best treatment with the assistance of
qualitative study,

Introduction:
Coronary artery disease affects more than 15 million Americans, making it a more
common form of heart disease. As discussed by Naganuma et al.(2016), it is a condition which
often results from the building up of plaque or waxy substances inside the arteries which supply
the blood to the heart. A significant number of medicine can be used for reliving the angina pain
which was developed from coronary heart disease (Pilz et al., 2014). However, since medicines
are not able to clear blocked arteries, specific surgeries are designed for clearing the block of the
arteries. While Percutaneous Old Balloon Angioplasty is widely accepted as a suitable treatment
for treating obstructive coronary heart disease because the technique is highlighted as a safe,
quick and patient may join the work earlier after bypass surgery (Law et al., 2015). It is a
technique where a small balloon catheter is used to induce surgical widening of narrowed arteries
in a patient with coronary artery disease (Bibbins-Domingo, 2016). However, the literature has
been documented that the balloon angioplasty reduces the chances of development of restenosis
(reoccurrence of abnormal narrowing of an artery even after surgery) up to 40% ( Scheinert et
al., 2016). On the other hand, stent replacement is a procedure where metal mesh tube is used
which keeps the arteries open. It reduces the risk of developing restenosis rate to 10 to 20%
(Mosca et al., 2016). Hence, stent replacement has been demonstrated to be superior in the de
novo focal lesion in native vessels
Objective:
The purpose of the study is to compare the treatments of coronary artery disease such as
coronary stent replacement and balloon angioplasty in the elderly patient with coronary heart

disease and evaluate the outcome of the disease. The research would be directed by research
question such as
“Which treatment is more effective for coronary artery disease between Coronary-stent
placement and balloon angioplasty?”
Method:
Study design:
In order to identify which is the better treatment for coronary heart disease in, the most
appropriate nature of the study is qualitative study as it provides the relevant and possible results
for the preliminary study which will further assist to gain the understanding which intervention
would be effective for managing coronary artery disease. The research was conducted using
various electronic databases such as Medline, CINAHL, and PubMed. The key terms that were
used for conducting the study include “coronary artery disease”, “ coronary stent replacement
in coronary heart disease”, “ balloon angioplasty in coronary heart disease.’ Two Boolean
operators such as used AND OR were used to obtain an accurate result.
Population:
Only those papers where included which undertaken the inclusion criteria were 1) 2010
to 2019 years 2) the patients who experienced coronary heart disease and undergoing one the
surgeries. The patients with myocardial infarction were excluded from the study.
Data collection:
Once search terms were given the databases were given, 423 journals were identified
which further filtered for eliminating duplication. After removing duplication, approximately

52 papers were identified. After elimination of all irrelevant articles, 4 articles were identified
which met the inclusion criteria.
Data analysis:
During data analysis, the data were analyzed using the outcome measured such as
Restenosis, minimal luminal diameter, bleeding and vascular complications and rate of hospital
stay. The data were analyzed in order to gather relevant information which further helps in
recommending the best possible treatments. These gathered pieces of information are the
representation of the treatment which is more effective in patients with coronary heart disease.
Results:
The findings of the research paper suggested that in older patients who are experiencing
coronary artery disease undergone mostly two treatment such as coronary stent replacement and
balloon angioplasty (Byrne et al., 2016). Majority of the study suggested that stenting has a
higher success rate compared to balloon angioplasty. While both the surgical process are safe
and highly efficient in nature, the restenosis rate is lower compared to the patients who have
undergone balloon angioplasty (Her et al., 2016). The result suggested that there is no
complication observed during hospital stays and even the patients with coronary artery patients
can return to the workplace after bypass surgery or stent replacement within a shorter period of
time compared to balloon angioplasty (Scheinert et al., 2016). Patients even experience a lesser
degree of stenosis or occurrence of stenosis immediately after a surgical process such as stent
replacement. Hence, stent replacement is better treatment procedure in a patient with coronary
artery disease compared to balloon angioplasty. However, in 80% of the cases, patients are
recommended combined surgery in order to remove the blockage of arteries.

Discussion:
Coronary artery disease is defined as the condition where blockage of heart vessels was
observed because of presence cholesterol in arteries (Scheinert et al., 2017). As the plaque
buildup in arteries, the arteries become narrowed, making it more difficult for flowing blood to
the heart. As the blockage of arteries gets worse, the blood flows to the heart becomes
substantially slow and develop a condition called angina. After the development of angina, the
narrowed artery leads to a heart attack. Percutaneous Old Balloon Angioplasty is widely
accepted as a suitable treatment for treating obstructive coronary heart disease because the
technique is highlighted as a safe, quick and patient may join the work earlier after bypass
surgery (Chen et al., 2014). However, comparing to balloon angioplasty, the result suggested that
stent replacement is better treatment procedure. The prime reason behind is the structure of these
two surgical equipment (Scheinert et al., 2017). In balloon angioplasty, a small balloon catheter
is used for inducing surgical widening of narrowed arteries in a patient with coronary artery
disease (Scheinert et al., 2017). Consequently, the process facilitates the growth of tissues and
normal blood flow in the arteries of the heart. However, Chalmers et al. (2013), suggested that
about 35 to 40% of the patients who have balloon angioplasty are a higher rate of blockage after
six months of surgery since the balloon is no longer present in arteries. On the other hand, the in-
stent replacement procedure, a small metal mesh tube was used in patients with coronary artery
disease (Law et al., 2016). This small mesh tube keeps the arteries open and removes the
blockage which was observed before. The presence of the mesh tube prevents the blockage of
arteries (Pilz et al., 2016). However, other researchers also suggested that patients with stent
replacement therapy may experience stoke because of blood clot around the stent which is a rare

phenomenon. Hence, in order to recommend the surgical procedure, clinicians are required to
conduct a thorough assessment for eliminating these risk factors (Pilz et al., 2014).
The limitation of the study is that in order to address the research question, this paper has
conducted primary research from databases and focused on older adults. The paper also
neglected the other outcome measures of stent replacement. Hence, in order to remove the bias
from the research, it is required to conduct through primary research such as randomized
controlled trial to validate the result of research.
Conclusion:
Thus it can be concluded that Coronary artery one of the deadly disease that contributed
to a high morbidity rate. Coronary artery disease is defined as the condition where blockage of
heart vessels was observed because of presence cholesterol in arteries. This paper investigated
and compared coronary stent replacement and balloon angioplasty in order to find out which is
better treatment procedure for patients with coronary artery disease. In order to identify which is
the better treatment for coronary heart disease in, the paper has undertaken qualitative research.
The result suggested that stent replacement is better to produce since the small mesh tube keeps
the arteries open and removes the blockage which was observed before, unlike balloon
angioplasty which just removes the blockage by widening the vessels. Hence, in a clinical
setting, patients are recommended to have combined surgery to improve their heart condition.

References:
Bibbins-Domingo, K. (2016). Aspirin use for the primary prevention of cardiovascular disease
and colorectal cancer: US Preventive Services Task Force recommendation
statement. Annals of internal medicine, 164(12), 836-845.
Byrne, R. A., Neumann, F. J., Mehilli, J., Pinieck, S., Wolff, B., Tiroch, K., ... & Hausleiter, J.
(2013). Paclitaxel-eluting balloons, paclitaxel-eluting stents, and balloon angioplasty in
patients with restenosis after implantation of a drug-eluting stent (ISAR-DESIRE 3): a
randomised, open-label trial. The Lancet, 381(9865), 461-467.
Chalmers, N., Walker, P. T., Belli, A. M., Thorpe, A. P., Sidhu, P. S., Robinson, G., ... & Fearn,
S. A. (2013). Randomized trial of the SMART stent versus balloon angioplasty in long
superficial femoral artery lesions: the SUPER study. Cardiovascular and interventional
radiology, 36(2), 353-361.
Chen, J., Zhou, S., Jin, J., Tian, F., Han, Y., Wang, J., ... & Chen, Y. (2014). Chronic treatment
with trimetazidine after discharge reduces the incidence of restenosis in patients who
received coronary stent implantation: a 1-year prospective follow-up study. International
journal of cardiology, 174(3), 634-639.
Gerhard-Herman, M. D., Gornik, H. L., Barrett, C., Barshes, N. R., Corriere, M. A., Drachman,
D. E., ... & Lookstein, R. (2017). 2016 AHA/ACC guideline on the management of
patients with lower extremity peripheral artery disease: a report of the American College
of Cardiology/American Heart Association Task Force on Clinical Practice
Guidelines. Journal of the American College of Cardiology, 69(11), e71-e126.

Her, A. Y., Ann, S. H., Singh, G. B., Kim, Y. H., Yoo, S. Y., Garg, S., ... & Shin, E. S. (2016).
Comparison of paclitaxel-coated balloon treatment and plain old balloon angioplasty for
de novo coronary lesions. Yonsei medical journal, 57(2), 337-341.
Law, M. A., McMahon, W. S., Hock, K. M., Zaccagni, H. J., Borasino, S., & Alten, J. A. (2015).
Balloon angioplasty for the treatment of left innominate vein obstruction related
chylothorax after congenital heart surgery. Congenital heart disease, 10(4), E155-E163.
Naganuma, T., Latib, A., Sgueglia, G. A., Menozzi, A., Castriota, F., Micari, A., ... & Presbitero,
P. (2015). A 2-year follow-up of a randomized multicenter study comparing a paclitaxel
drug-eluting balloon with a paclitaxel-eluting stent in small coronary vessels the BELLO
study. International journal of cardiology, 184, 17-21.
Pilz, S., Verheyen, N., Grübler, M. R., Tomaschitz, A., & März, W. (2016). Vitamin D and
cardiovascular disease prevention. Nature Reviews Cardiology, 13(7), 404.
Scheinert, D., Katsanos, K., Zeller, T., Koppensteiner, R., Commeau, P., Bosiers, M., ... & Van
Ransbeeck, M. (2012). A prospective randomized multicenter comparison of balloon
angioplasty and infrapopliteal stenting with the sirolimus-eluting stent in patients with
ischemic peripheral arterial disease: 1-year results from the ACHILLES trial. Journal of
the American College of Cardiology, 60(22), 2290-2295.
Stewart, J., Manmathan, G., & Wilkinson, P. (2017). Primary prevention of cardiovascular
disease: A review of contemporary guidance and literature. JRSM cardiovascular
disease, 6, 2048004016687211.