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Coronary artery bypass - Alternatives to heart bypass

NHS Choices Medical Reference

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The most common surgical alternative to a coronary artery bypass graft (CABG) is a

coronary angioplasty

.

Coronary angioplasty

During a coronary angioplasty, a long, flexible hollow plastic tube called a catheter (about the width of the lead in a pencil) is inserted into a blood vessel, either in your groin or your arm.

The tip of the catheter is guided under X-ray to the arteries that supply your heart, to the point where the narrowing of the artery has occurred.

A balloon attached to the catheter is then inflated to widen the artery and a small metal tube called a stent is often used to help keep the artery open.

Complications of a coronary angioplasty are uncommon, but can be serious and include:

  • heart attack, which is estimated to occur in 1 in 100 cases
  • stroke, which is estimated to occur in 1 in 200 cases
  • excessive bleeding after the operation, which is estimated to occur in 1 in 200 cases and requires a blood transfusion
  • death, which is estimated to occur in 1 in 500 cases

A coronary angioplasty may not be recommended if multiple coronary arteries have become blocked and narrowed. It may also not be technically possible if the anatomy of the blood vessels near your heart is abnormal.

CABG or coronary angioplasty?

If you are able to choose between having a coronary angioplasty or a CABG, be aware of the advantages and disadvantages of each technique.

As a coronary angioplasty is non-invasive, you will recover from the operation quicker than you would from a CABG. Angioplasty also has a lower complication rate.

Research has shown that one person in four who has a coronary angioplasty requires further surgery because the widened artery narrows again. However, the number of people who need further surgery will probably fall sharply in the future due to the use of new stents that slowly release a medication that helps prevent the artery from narrowing again.

CABG has a longer recovery time than coronary angioplasty and a higher complication rate. However, only one person in 10 who has a CABG requires further surgery.

Also, research published in 2009 found that CABG is usually a more effective treatment option for people who are over 65 years old and for those with diabetes.

Discuss the benefits and risks of both types of surgery with your surgical team.

Medical Review: April 20, 2012
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