Alternatives to a coronary artery bypass

If you have coronary heart disease and the arteries around your heart are severely narrowed, it may be possible to have a procedure called a coronary angioplasty instead of a coronary artery bypass graft (CABG).

Coronary angioplasty

During a coronary angioplasty, a long, flexible plastic tube called a catheter is inserted into a blood vessel, either in your groin or 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 inflated to widen the artery and a small metal tube called a stent is often left in the affected section ofartery to help keep it open.

It's uncommon for a coronary angioplasty to have serious complications. Heart attacks, strokes and deaths are estimated to occur inless than one in every 100 cases.

It's unlikely a coronary angioplasty will 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.

Which procedure is best?

You may not always be able to choose between having a coronary angioplasty or a coronary artery bypass graft, but if you are it's important to be aware of the advantages and disadvantages of each technique.

As a coronary angioplasty is minimally invasive, you'll recover from the effects of the operation quicker than you will from acoronary artery bypass graft. Coronary angioplasty usually has a smaller risk of complications, but there's a chance you'll need further treatment because the affected artery may narrow again.

However, the number of people who need further treatment has fallen in recent years because of the use of special drug-eluting stents that reduce the risk of the artery narrowing again. See how a coronary angioplasty is performed for more information about these.

A coronary artery bypass graft has a longer recovery time than coronary angioplasty and a higher risk of complications. However, only one person in 10 who has a coronary artery bypass graft needs further treatment.

There's also some evidence to suggest thata coronary artery bypass graft is usually a more effective treatment option for people over 65 years of age and particularly for people with diabetes .

If possible, you should discuss the benefits and risks of both types of treatment with your cardiologist and cardiac surgeon before making a decision.

Medication

In some cases, it's possible to treat coronary heart disease with a number of different medications, such as:

• antiplatelets to help prevent your blood from clotting and reduce your risk of problems, such as heart attacks
• statins to help reduce high cholesterol
• beta-blockers and nitrates to help prevent angina and treat high blood pressure

These medications can help control some of the symptoms of coronary heart disease and can reduce the risk of the condition getting worse. However, a coronary artery bypass graft may be recommended if the condition is severe or there's a particularly high risk of serious problems, such as heart attacks, because it's a more effective treatment in these cases.