I'm getting a cardiac catheterization. If blockages are found, what's the best treatment, angioplasty or bypass surgery?
Answer From Rekha Mankad, M.D.
During cardiac catheterization, your doctor will examine images of the inside of your coronary arteries. If plaques in these arteries (coronary artery disease) have caused areas of narrowing, you may need treatment. 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 diabetes, peripheral artery disease, or prior stroke or heart attack
For some people, medications and lifestyle changes may be the treatment of choice.
In other cases, angioplasty — also known as percutaneous coronary intervention — may be recommended to open the clogged arteries. Angioplasty may especially be recommended if you are having chest discomfort (angina) due to reduced blood flow that has not responded to medication and lifestyle changes.
During angioplasty, your doctor inserts a tiny balloon at the site of the blockage and expands it to widen the narrowed artery. Your doctor then may implant a small metal coil (stent) in the clogged artery to keep 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 most appropriate treatment option for you.
If your arteries are narrowed or blocked in multiple areas, or your left main coronary artery is narrowed, your doctor may recommend coronary bypass surgery. Some studies show coronary bypass surgery may also be an appropriate treatment if you have multiple blocked or narrowed arteries and diabetes.
During bypass surgery, surgeons take a section of healthy blood vessel — often from inside the chest wall or the lower leg — and attach it above and below the blocked artery. This allows blood to bypass the blocked area and flow to the heart muscle.
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- Cutlip D, et al. Revascularization in patients with stable coronary artery disease: Coronary artery bypass graft surgery versus percutaneous coronary intervention. http://www.uptodate.com/home. Accessed Jan. 25, 2016.
- Fihn SD, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. The Journal of Thoracic and Cardiovascular Surgery. 2015;149:e5.
- What is coronary heart disease? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/cad#. Accessed Jan. 27, 2016.
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March 19, 2016Original article: http://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/expert-answers/coronary-artery-disease/FAQ-20058302