Personal video: http://news.cntv.cn/2014/02/04/VIDE1391512501451947.shtml?ptag=vsogou Many patients with a clear diagnosis of coronary artery disease and clear symptoms of angina are often unable to make up their minds whether bypass or stent implantation is better. This question can not be answered in one sentence. It used to spread on the Internet, “If stent placement is greater than three, you should choose bypass.” This is a complete misinterpretation by the media or certain departments of some experts’ talks out of context or on purpose. Mao Yi, cardiovascular medicine department of Beijing Fu Wai Hospital, first of all, let’s understand the procedure of bypass surgery.1, take the saphenous vein bridge: first take the vein from the leg, one end is connected to the aorta, one end is connected to the coronary artery, which section of the coronary artery is ischemic, then connect to which section. Usually 2-3 vein bridges are made for bypass patients. So it is required to have good veins in the legs in order to have material available. In addition, after this kind of bridge, the occlusion rate reaches 50% in 5 years.2, Bypass the internal mammary artery bridge: an artery is free from under one’s own sternum, called the left internal mammary artery. The distal end is built to the middle and distal part of the anterior descending branch of the coronary artery (the most important coronary artery in the body, responsible for supplying 50-70% of blood to the heart muscle). This bridge has a 10-year patency rate of 90%, but each person can only have one bridge. 3, radial artery bridge: The radial artery of the left hand is taken and used as a vein and is attached to the coronary artery. This kind of bridge is less used. The patient should have good pulmonary function first and respiration should be able to keep up after surgery. Cerebrovascular problems should not be too severe. Because most bypass patients have to have their heart stop during the bypass, some elderly patients may not wake up when their heart resumes after successful surgery. In addition, the coronary vessels in the heart should be larger than 1 mm in diameter at the point where they are intended to be sutured, otherwise it is difficult to suture them properly despite wearing a microscope. Therefore, patients whose vessels are too thin to be sutured cannot be bypassed. Patients who have poor physical condition and cannot tolerate open-heart surgery are not suitable for bypass. In patients who have no problems with the anterior descending branch of the coronary artery, but have poor other vessels, it is better to have a venous bridge than to put a stent. That’s why sometimes surgeons also recommend stenting, even though stents have to be placed a lot. Coronary stenting treatment is performed by puncturing the radial or femoral artery, introducing a balloon, dilating the stenosis in the coronary artery, and then implanting a stent to hold up the lesion. The trauma is relatively small and the recovery after the procedure is quick, so more and more patients are receiving stenting. Many patients who are physically unable to tolerate bypass are successfully undergoing intervention with good results. Since such patients tend to have more lesions and are longer, the number of stents implanted is often greater than three. Stenting seems to be a simple procedure, but in fact there are still many technical bottlenecks and greater risks. Every year, patients die from complications related to interventional procedures. In our hospital, we perform more than 10,000 stenting procedures each year, and the mortality rate is controlled at less than 0.2%. Stenting can manage almost all coronary lesions, but it is not always the best option for many patients. Within 1 month after implantation, there is a possibility of acute in-stent thrombosis of about 0.5%, which is often fatal; 1 month after implantation, there is a possibility of late in-stent thrombosis of 1-2%; 1 year after stent implantation, there is an 8% in-stent restenosis rate; stenting has a long-term mortality rate of 1.5-3.1% for left main + three branch lesions, compared to 0.5-1.1% for bypass surgery. Therefore, many times, medical interventionalists, from the perspective of maximizing patient benefit, recommend bypass surgery for some patients. In Fu Wai Hospital, there are more than 10,000 bypass surgeries each year, and the mortality rate is below 0.5%, which is ahead of other hospitals in China and in the international advanced level. But after all, it is a major open-heart surgery with cardiac arrest, extracorporeal circulation and general anesthesia, so there is still some systemic risk inevitably.