Alternatives to Coronary Stenting: Effective Heart Disease Treatments

Coronary stenting (PCI) is one option for obstructive coronary artery disease. Alternatives depend on anatomy, symptoms, comorbidities, and patient preference:

1. Optimal Medical Therapy (OMT): High‑intensity statin, antiplatelet (aspirin ± P2Y12), beta‑blocker, ACEi/ARB, SGLT2 inhibitor, lifestyle.
2. Lifestyle modification: Mediterranean diet, 150 min/week moderate exercise, smoking cessation, stress management.
3. Balloon angioplasty (POBA): Plain old balloon angioplasty—higher restenosis, but avoids stent.
4. CABG: Surgery for left main, multivessel, diabetes, complex anatomy; durable revascularization.
5. Emerging percutaneous:
   • Drug‑coated balloons (DCB)
   • Intravascular lithotripsy (IVL) for calcified lesions
   • Bioresorbable scaffolds (BRS)
   • Orbital/rotational atherectomy
   • Laser atherectomy
6. EECP: External counterpulsation for refractory angina.
7. TMR: Transmyocardial revascularization (laser channels).

Heart Team discussion (interventional cardiologist, cardiac surgeon, clinical cardiologist) guides optimal strategy per guidelines (ACC/AHA/ESC).