I'm getting a cardiac catheterization. If blockages are found, what's the best treatment, angioplasty or bypass surgery?
Answers from Martha Grogan, M.D.
During cardiac catheterization, your doctor will examine images of the inside of your coronary arteries. If cholesterol plaques in these arteries (coronary artery disease) have caused areas of narrowing, treatment options depend on various factors, including:
- Severity and extent of coronary artery disease
- Symptoms, such as chest pain and shortness of breath
- Overall heart function
- Other medical conditions, such as heart valve disease, diabetes, kidney disease, peripheral artery disease, or prior stroke or heart attack
For some people, medications and lifestyle changes may be the treatment of choice — especially if only one artery is narrowed.
In other cases, angioplasty may be recommended to open the clogged arteries — especially if you are having chest discomfort (angina) due to reduced blood flow that has not responded to medication and lifestyle changes. During angioplasty, a tiny balloon is inserted and expanded at the site of the blockage to widen the narrowed artery. Typically, a small metal coil called a stent is implanted in the clogged artery to help prop the artery open and reduce the risk of it narrowing again. It's possible you may even have angioplasty during your cardiac catheterization, if your doctor thinks it's the best treatment option for you.
If your arteries are narrowed or blocked in multiple areas, coronary bypass surgery may be necessary. During bypass surgery, a section of healthy blood vessel — often taken from inside the chest wall or the lower leg — is attached above and below the blocked artery. This allows blood to bypass the blocked area and flow to the heart muscle.
May 15, 2013
- What is coronary angioplasty? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/angioplasty/. Accessed April 24, 2013.
- Levine GN, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention. Circulation. 2011;124:e574.
- Cutlip D, et al. Bypass surgery versus percutaneous intervention in the management of stable angina pectoris: Recommendations. http://www.uptodate.com/home. Accessed April 24, 2013.
- O'Gara PT, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction. Circulation. 2013;127:e362.