Angioplasty OR Bypass Surgery

A person suffering from Angina or any coronary artery diseases may need either Angioplasty or Bypass surgery

• Angioplasty to widen the narrowed artery
• Coronary artery bypass surgery to create a separate blood vessel which will supply the heart

What is Angioplasty?

Angioplasty is the technique of mechanically widening a narrowed or obstructed blood vessel, the latter typically being a result of atherosclerosis. An empty and collapsed balloon on a guide wire, known as a balloon catheter, is passed into the narrowed locations and then inflated to a fixed size using water pressures some 75 to 500 times normal blood pressure (6 to 20 atmospheres). The balloon crushes the fatty deposits, opening up the blood vessel for improved flow, and the balloon is then deflated and withdrawn.

Advantages of Angioplasty:

• Non-surgical procedure
• Recovery time is quick – usually just about a day
• Can be performed under local anesthesia (Patient is under sedation but awake)
• Chest does not have to be opened
• No use for a heart-lung machine which reduces the chances of stroke

Sounds good? So then what’s the problem with Angioplasty?

Some patients who have undergone Angioplasty may have to undergo the procedure once again or may even have to undergo a bypass surgery (recommended because a repeat angioplasty could be fatal or ineffective in some cases). This is due to a problem called restenosis. What is Restenosis?

‘Restenosis literally means the reoccurrence of stenosis, a narrowing of a blood vessel, leading to restricted blood flow. Restenosis usually pertains to an artery or other large blood vessel that has become narrowed, received treatment to clear the blockage and subsequently become renarrowed’. 

Today due to advancements in medical technology, stents are used in Angioplasty which to an extent reduces the occurrence of restenosis as the artery is kept open. However Stents come with its own risks. A patient who has an implanted stent may have to take medications up to a year as there is a risk of formation of clots around the stent in the long run.

Situation:

My doctor recommends an Angioplasty. He also adds I may have to undergo the procedure at a later stage. Cant I just have a bypass if I have to undergo Angioplasty several times?

Doctors recommend Angioplasty depending on the medical reports. Since the entire procedure itself is less stressful for the patients, doctors try it at least once. Even if a repetition of the procedure is required for long lasting results, we recommend this because it is a less stressful procedure for YOUR BODY.

Under what circumstances is Angioplasty NOT recommended?

• Severe plaque buildup in a particular location of the artery. It is usually risky to perform Angioplasty in this area, often fatal
• Some people have narrowed arteries in several places – widening every block with angioplasty is just plain impractical
• Severe narrowing of the left main coronary artery
• Severe narrowing of any three arteries in a person who ALSO has a less EF (Ejection fraction) or simply put a heart that beats slow/weak
• Severe narrowing of the left anterior descending artery and at least one other coronary artery, plus either diabetes or a weakly pumping heart

In all above circumstances, a bypass surgery is recommended

There is a little math that goes in to all of this:

There is one important factor we consider in deciding between Angioplasty or Cardiac Bypass Surgery. That is to measure whether your heart is pumping weakly or strongly

Using one of the several imaging methods, we measure:

• How much blood flows from the upper chamber of the heart to the lower chamber
• Ejection fraction: Fraction of blood that is squeezed out with every beat.

A heart that has an ejection fraction of 50% or more can withstand an Angioplasty. If the numbers are poor, we go for a bypass surgery.

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