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Friday, 12 May, 2000, 00:33 GMT 01:33 UK
Doctors told: 'Take the tube'
heart surgery
The need for risky bypass surgery could be reduced
Many heart patients should be getting a cheaper and far less painful alternative to bypass surgery, an expert advisory group says.

Coronary artery stents - flexible mesh tubes - can be inserted in blood vessels hardened by heart disease.

They help keep the artery open, and maintain blood flow to the heart muscle, thereby reducing the chance of angina symptoms, or even a heart attack.

The National Institute for Clinical Excellence (Nice), a body set up by the government to evaluate both new and existing treatments, has told doctors that putting in a stent should be a routine alternative to a far more serious heart bypass operation in some cases.

An estimated 23,000 people a year undergo balloon angioplasty, in which a balloon is passed into the coronary artery and expanded to widen it.


heart
The stent can placed in the arteries surrounding the heart
The new advice is that these patients should automatically have a stent tube inserted to keep the blood vessel open.

At present, only 70% of angioplasties involve stenting.

There will still be many cases in which a heart bypass will be the only option for doctors.

But using a combination of balloon angioplasty and stent in even a few thousand cases would save the NHS hundreds of thousands of pounds.

After angioplasty and stent, the patient normally spends just one night in hospital, and can be discharged on the same day.

Following heart bypass, a patient will need to spend time in an expensive intensive care bed, plus four to six days in hospital.

Major operation

In addition, bypass surgery is a major operation and carries many more risks for the patient, who will spend much longer recovering and in pain.

Eve Knight, of the British Cardiac Patients Association, welcomed the Nice guidance: "There is a major challenge to ensure that patients know about the availability of stents and that medical professionals consider this innovative solution."

Britain lags behind other countries in its use of stent technology - for example, Germany uses stent and angioplasty operations three times more frequently.

Dr Ray Wainwright, a consultant cardiologist at King's College Hospital in London, said: "All the evidence strongly suggests that this technique is one of the better ways to manage people with coronary heart disease.

"It is cheaper than bypass surgery and there is good evidence to support the fact that it is just as effective as bypass surgery and in certain patient groups, such as the elderly, it is a much safer procedure."

A spokesman for the British Heart Foundation, said: "Over the last few years stents have been used increasingly because they offer significant benefits for patients, helping to reduce the need for emergency surgery and lessening the recurrence of coronary artery narrowing after angioplasty."

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