Many patients with coronary artery disease often cannot decide whether it is better to choose bypass or to implant a stent. This question can’t be fully answered in one or two sentences either. It was once spread on the Internet that “if stent placement is greater than three, bypass should be chosen.” This is a complete misinterpretation of some experts’ talk by the media or some departments out of context or on purpose, and it seems very arbitrary. In fact, whether to choose bypass or stent, to consider a number of aspects, more should listen to the experts. Let’s first understand the bypass surgery process. Li Chongjian1, cardiovascular medicine department of Beijing Fu Wai Hospital, take a saphenous vein bridge: first take a 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, it is connected 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 stent placement treatment A balloon is introduced through a radial or femoral artery puncture to dilate the stenosis in the coronary artery and then a stent is implanted to hold up the lesion. The trauma is relatively small and 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. Restenosis and thrombosis are two major problems. Stenting can manage almost all coronary lesions, but it is not always the best option for some patients. There is a 0.5% or so chance of acute in-stent thrombosis within 1 month after implantation, which is often fatal; a 1-2% chance of late in-stent thrombosis 1 month after implantation; an 8% rate of in-stent restenosis 1 year after stenting; and a 1.5-3.1% long-term mortality rate for stenting 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. The annual bypass surgery in Fu Wai Hospital is more than 10,000 cases, 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 inevitably still a certain amount of systemic risk.