Coronary artery disease: Angioplasty or bypass surgery?

During cardiac catheterization, a health care professional looks at images of the inside of the heart arteries, called the coronary arteries. If the arteries are narrowed, treatment choices depend on many factors, including:

• How bad the coronary artery disease is.
• Symptoms, such as chest pain and shortness of breath.
• How well the heart works.
• Other medical conditions, such as heart valve disease, diabetes, kidney disease, peripheral artery disease, or prior stroke or heart attack.

For some people, medicines and lifestyle changes may be the first treatments, especially if only one artery is narrowed.

In others, angioplasty and stenting may be needed if chest pain, called angina, due to reduced blood flow has not improved with medicines and lifestyle changes. During angioplasty, a health care professional puts a tiny balloon in at the site of the blockage and expands it. This widens the narrowed artery.

Usually a small metal coil called a stent is placed in the artery. The stent keeps the artery open. It also reduces the risk of renarrowing.

Coronary artery stent

To place a coronary artery stent, a balloon on the tip of the catheter is inflated to widen the blocked artery (A). Then a metal mesh stent is placed (B). The stent helps hold the artery open so blood can flow through it (C).

Coronary artery bypass surgery

Coronary artery bypass surgery creates a new path for blood to flow to the heart. A healthy blood vessel from another part of the body is used to redirect blood around a blocked area of an artery. Usually the blood vessel is taken from an artery in the chest, called the internal mammary artery. Sometimes it's taken from a leg vein, called the saphenous vein.

If your arteries are narrowed or blocked in several areas, you might need coronary bypass surgery. This also might be true if you have a blockage in one of the larger main arteries.

During bypass surgery, a surgeon creates a new path for blood to flow around a blocked or partially blocked artery in the heart. The surgery involves taking a piece of healthy blood vessel from inside the chest wall or lower leg area. The vessel is connected below the blocked heart artery. The bypass improves blood flow to the heart muscle.