The most widely used surgical alternative to a coronary angioplasty is a coronary artery bypass graft (CABG).
Coronary artery bypass graft
A coronary artery bypass graft (CABG) is surgery to bypass a blockage in an artery. This is done using segments of healthy blood vessel, called grafts, taken from other parts of the body. Segments of vein from your legs or chest are used to create a new channel through which blood can be directed past the blocked part of the artery. This allows more blood to get through into the heart muscle.
Complications of CABG are uncommon, but are potentially serious. They include:
- a heart attack, which is estimated to occur in 1 in 50 cases
- a stroke, which is estimated to occur in 1 in 50 cases
You may not always be able to choose between having a coronary angioplasty or a CABG.
A CABG is usually recommended when multiple coronary arteries have become blocked and narrowed. However, it is invasive surgery so may not be suitable for people who are particularly frail and in poor health.
A coronary angioplasty may not be possible if the anatomy of the blood vessels near your heart is abnormal.
Coronary angioplasty or CABG?
If you can choose between having a coronary angioplasty or a CABG, be aware of the advantages and disadvantages of each technique.
As a coronary angioplasty is minimally invasive, you will recover from the effects of the operation quicker than you will from a CABG. The procedure also has a lower complication rate, but research has shown that up to one person in four who has a coronary angioplasty requires further treatment because the widened artery narrows again.
However, in the future, the number of people who need further surgery will probably fall sharply because of the use of drug-eluting stents.
CABG has a longer recovery time than coronary angioplasty and a higher complication rate. However, only 1 person in 10 who has a CABG requires further treatment. Also, research published in 2009 found that CABG is usually a more effective treatment option for people who are over 65 years of age and for people with diabetes.
Discuss the benefits and risks of both types of surgery with your surgical team.
Percutaneous transluminal coronary rotational atherectomy (PTCRA)
Percutaneous transluminal coronary rotational atherectomy (PTCRA) is a similar technique to coronary angioplasty. However, rather than using a balloon and a stent to expand the artery, a small diamond cutter is first used to remove the fatty deposit that is blocking the artery
It is usually used when the coronary artery has a high level of calcium in it. Calcium makes the artery very hard and can prevent balloons or stents expanding properly to relieve the narrowing. Once the small diamond cutter has been used, the artery is then treated with balloons and stents as normal.
Evidence has found that PTCRA is no more effective than a coronary angioplasty, so it is usually only carried out in people who are not suitable for conventional coronary angioplasty.
