There have also been several studies since 2007 showing that in CCS, not all patients with stenting benefit more- in terms of reduced death risk- than those who adopted a healthy lifestyle and medications only without stenting.

There are certain situations when patient will benefit from balloon and stenting to clear blocked vessel(s) or heart surgery to bypass blocked vessels. 

In these situations, the risk of premature death is reduced. 

• Those with significant blockage in left main coronary artery.
• Those with multiple significant coronary artery blockages with weakened cardiac function or diabetes mellitus.

There are certain other situations when patient will benefit from stenting to unblock vessel. In these situations, the benefit of stent placement is to:

• resolve angina symptoms, allowing one to go back to their usual activities, thus improving quality of life or
• to reduce acute symptoms requiring urgent stent placement.

These situations include the following:

• coronary artery blockages that are significant. These are defined as follows
  • There is significant pressure difference between pressures after and before the blockage. These pressures are measured during invasive coronary angiography with a Fractional Floor Reserve Pressure Wire.
  • The coronary artery cross section area is small as determined by specialised imaging methods:
    • Intravascular ultrasound (IVUS) or
    • Optical Coherence Tomography (OCT).
• Heart symptoms persisting and not relieved with medications, thus affecting the quality of life.
• Patient has allergies or side effects to or unable to tolerate the heart medications to treat the heart symptoms.
• Patient wants a faster return to their prior active lifestyle.

Regardless, whether stenting or bypass operation is done, patient must adopt a healthy lifestyle and take their medications regularly to stabilize the coronary artery plaques, to prevent plaque size getting bigger, and thus reduce the risk of ACS and premature death.