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, a health care provider examines images of the inside of the heart (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 others, angioplasty may be recommended to open the clogged arteries — especially if chest pain (angina) due to reduced blood flow has not improved with medication and lifestyle changes. During angioplasty, the health care provider inserts a tiny balloon at the site of the blockage and expands it, which widens the narrowed artery. Usually, 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 care provider 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.


Rekha Mankad, M.D.

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Jan. 14, 2022 See more Expert Answers