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 cholesterol plaques in these arteries (coronary artery disease) have caused areas of narrowing, your 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 have chest pain (angina) due to reduced blood flow that has not improved with medication and lifestyle changes. During angioplasty, the doctor inserts a tiny balloon at the site of the blockage and expands it, which widens the narrowed artery. In most cases, a small metal coil called a stent is placed in the clogged artery to help keep the artery open and reduce the risk of it narrowing again. Angioplasty may be done during your cardiac catheterization if your doctor thinks it's the best treatment option for you.
If your arteries are narrowed or blocked in several areas, or if you have a blockage in one of the larger main arteries, 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 lets blood flow around the blocked area to the heart muscle.
Jan. 15, 2020
- Percutaneous coronary intervention. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/percutaneous-coronary-intervention. Accessed Nov.13, 2019.
- Levine GN, et al. 2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: An update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction. Journal of the American College of Cardiology. 2016;67:1235.
- Cutlip D, et al. Revascularization in patients with stable coronary artery disease: Coronary artery bypass graft surgery versus percutaneous coronary intervention: Recommendations. https://www.uptodate.com/contents/search. Accessed Nov. 13, 2019.
- Mankad R. (expert opinion). Mayo Clinic. Nov. 13, 2019.