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Bypass Vs. Angioplasty: Which One to Choose?

Bypass Vs. Angioplasty: Which One to Choose?

In case of blocked arteries, which procedure is ideal, bypass or angioplasty? The decision should be the result of a consensus between the patient-doctor team, and a well-informed patient would become a better member of the team.
Meghna Wani
Last Updated: Apr 30, 2018
Did you know... ...
that only one-third of all the patients with Coronary Artery Disease (CAD) undergo an angioplasty and about 10% undergo a bypass surgery. The rest manage their condition with medication and lifestyle changes.

After reading the angiogram, if the cardiologist declares that one or more of the coronary arteries are blocked, it means the person is diagnosed with Coronary Artery Disease (CAD). Now, the decision to go for a bypass surgery or angioplasty has to be taken. More often than not, it will be the doctor who will decide which procedure is ideal.

If the symptoms are mild, and can be managed with some drugs and lifestyle changes, then the doctor may even suggest treatments that are less aggressive than an angioplasty or a bypass surgery.

And, in situations where only one or two arteries are blocked, and neither of them are the left main or the triple-vessel (the right anterior descending, left anterior descending and left circumflex arteries), you have a choice to choose between the two procedures. 

What is Coronary Artery Disease (CAD)?

In short, a person is diagnosed with CAD when plaque starts building up in the coronary arteries and obstructs the normal flow of blood to the heart. He will start experiencing certain symptoms, such as chest pain (angina pectoris) that can radiate to the arm, neck or back, breathlessness and sometimes, fatigue. CAD may predispose a person to develop a heart attack and in severe cases, may cause failure of the heart.

What is an Angioplasty?

In an angioplasty [also known as percutaneous coronary intervention (PCI)], the surgeon will insert a long tube through the artery in the arm or the groin area. It has a stent and a tiny balloon at the tip. When the tube reaches the point of blockage, the balloon is inflated which in turn, opens up the meshed stent and secures it in place. The tube with the balloon is withdrawn. One major advantage of this procedure is that it is minimally invasive, so the patient goes home after 1 or 2 days of hospital stay.

What is a Bypass Surgery?

In a bypass surgery [also known as coronary artery bypass graft (CABG)], the surgeon initially takes a small graft from the chest, arm or leg vein and uses it to create an alternate route around the area of blockage. This surgery can be done on the same artery, that had undergone an angioplasty previously. It is seen that patients undergoing a bypass surgery have higher rates of success, as compared to those who have undergone an angioplasty.

Bypass Vs. Angioplasty: Which One to Choose

When deciding on the preferred procedure, there are many aspects that need to be kept in mind by the patients. They should be aware of the questions to ask the doctor. Being knowledgeable and making an informed decision, will help in choosing the most appropriate procedure for their condition. 

Questions You Should Ask the Doctor
  • Q: Can a solution be sought without an operation?
    A: The patient should always ask the doctor if he is on the best possible medication for his condition. Also, he should inquire if medication coupled with some radical lifestyle changes, can spare him from an operation.
  • What would be the chances of survival with both the procedures?
  • In the long run, which procedure would provide better quality of life? 
  • What will be the duration of the hospital stay, and how soon can regular work be resumed?
  • What will be the short, as well as long-term complications associated with the selected procedure?
  • Q: If your doctor has suggested an angioplasty, ask him about the type of stent he will be using.
    A: It becomes essential for the patient to know this, because if the disease is not very severe, then a simple Bare-Metal Stent (BMS) would normally suffice. You should do some research on the cost of different heart stents.
  • What activities need to be avoided in the long run?
  • Should a specific diet be followed to avoid recurrence of a blockage?
  • Will medications be a life-long mandate?
  • What emergency instructions should be followed if sudden pain is experienced at the site of the operation?
  • The patient should also ask the doctor, if he has substantial previous experience of the type of the selected surgery and what is the success rate? 
  • The success rate of the hospital should also be considered before opting for it.

It should be remembered that there is no 'one-size-fits-all' formula here, it totally depends on the severity of the disease, his medical history and the overall health of the person. In layman terms, it can be said that an angioplasty is a quick fix solution that doesn't last very long, whereas a bypass is an exhaustive method that gives long-lasting results.

Some people may think that if they are not opting for a surgery, they are not doing enough to cure the disease. It is human tendency to think in such a manner, but keeping such an approach towards treatment will not help in the long run.

Disclaimer: This HealthHearty article is for informative purposes only and should not be used as a replacement for professional medical advice.