Angioplasty vs Bypass Surgery: Pros and Cons

In this article, we will take a close look at angioplasty and bypass surgery, two common treatments for coronary artery disease. We will explain these procedures, their success rates, and potential risks, providing a comprehensive comparison.
Jakub Gwiazdecki

Jakub Gwiazdecki

Fifth year medical student at the Medical Faculty of Comenius University in Bratislava.

A blue image with text saying "Angioplasty vs Bypass Surgery"

What is angioplasty?

Angioplasty, also known as percutaneous coronary intervention (PCI), is an invasive procedure which aims to improve blood flow in coronary arteries that are narrow or blocked [1]. The coronary arteries are responsible for supplying oxygen-rich blood to the heart. In some individuals atherosclerosis develops and a sticky material called plaque can build up in these arteries, leading to narrowing or complete blockage of the blood vessel. This can result in parts of the heart not receiving enough oxygen, a condition called ischemia [1]. Ischemia of the heart when not resolved quickly leads to myocardial infarction, which is referred to as heart attack.

People Also Ask

The risks associated with angioplasty include allergic reactions to medication or dye, breathing problems, bleeding, blood clots, infection, kidney damage, re-narrowing of the artery, and rupture of the artery. Rare side effects include stroke and seizure. However, the risks of not undergoing angioplasty may outweigh the risks associated with the procedure. It's important to discuss the benefits and risks with your doctor. [1], [2], [3], [4], [5]

Stents, particularly drug-eluting stents, have proven to be highly effective in preventing artery re-closure, or restenosis. The restenosis rate for coronary stenting is generally 10% to 20% but can be less than 10% when a drug-eluting stent is used [1,2]. For instance, the Xience V stent significantly reduced in-stent diameter stenosis to 21% and late lumen loss to 0.78 mm [3]. However, the effectiveness can vary based on patient conditions and complexity of lesions [2].

The angioplasty procedure is performed by the use of a catheter with a tiny inflatable balloon on the end. This catheter is inserted into the blood vessel, which is easy to access and leads to the aorta. Typically used are the radial and femoral arteries. They are reached through an incision in the arm or groin. Using X-ray, video, and special dyes, a technic named !angiography!, the catheter is guided up into the blocked coronary artery. Once at the affected area, the balloon is inflated to widen the artery. The fatty deposits, or plaque, get pushed against the wall of the artery, and open the way for blood flow [2].

In many cases, angioplasty is performed with the placement of a stent. It is a small wire-mesh open pipe. Its placement gives structural support to the newly opened artery and is meant to prevent the artery from closing. [3].

Bypass surgery

Bypass surgery is a medical procedure that aims to improve the blood flow to a certain part of the body or organ. It is performed by creating a new pathway for blood to bypass a blocked or damaged artery. The procedure involves taking a blood vessel from another part of the body and incorporating it in such a manner that the oxygen-rich blood reaches the area served by the malfunctioning artery. It can be done in many ways. [4]. The whole procedure planning depends on many factors including location and anatomy of the patient and the blood flow demand as well as capacity of the vessel to be implanted.

One of the most common types of bypass surgery is a coronary bypass surgery, called coronary artery bypass graft (CABG) surgery. It is used in cases when the angioplasty is not sufficient. Deciding factors include damage or blockage of an artery, its size and location, as well as whether there is a recurrence of this occlusion or damage. In the United States alone, doctors perform approximately 200,000 such surgeries each year [4].

Another type of bypass surgery is aortobifemoral bypass. This type is used to create a new path around a large, clogged blood vessel in the abdomen or groin. [5].

Bypass surgery is also used in the treatment of morbid obesity. Procedures such as the Roux-en-Y gastric bypass and laparoscopic one-anastomosis gastric bypass have been shown to produce sustained weight loss and resolve comorbidities associated with obesity [6, 7].

Pros and cons of angioplasty?

Angioplasty is a well-established treatment for coronary artery disease, with a high initial success rate. It is used as a therapeutic procedure in stable and unstable angina, as well as in some types of myocardial infarctions [8]. One of its merits is the quick recovery of the patient in acute as well as chronic conditions.

Note on coronary artery disease

Coronary artery disease is the illness, in which the process of atherosclerosis causes a plaque buildup in the coronary circulation of the heart. It leads to heart attack and arrythmia.

One of the major advantages of angioplasty is its, above-mentioned, high success rate. Studies show that the initial success rate of angioplasty ranges from 85% to 97% [9]. Furthermore, as angioplasty is a minimally invasive procedure it is less costly than coronary surgery. This makes it a more affordable option for many patients [8].

However, angioplasty is not without drawbacks. The main chronic complication of angioplasty is re-stenosis, or the re-narrowing of the artery. This usually occurs early, often within a few weeks passed the procedure. For each narrowing or blockage dilated, there is about a 30% chance of significant re-stenosis [8].

Acute closure of the dilated artery is another serious complication that can occur usually within an hour or two of the procedure. Due to this complication, PCI contributes 0.2% acute mortality rate. In such cases, emergency coronary artery bypass grafting is needed[8].

Other risks associated with angioplasty include bleeding, clotting, or bruising at the point of insertion. In the case of stent scar tissue or blood clots can form. There is also a risk for an irregular heartbeat, and damage to a blood vessel, heart valve, or artery. Patients undergoing a percutaneous coronary intervention are also at risk of a heart attack, kidney damage, and infection [2].

Pros and cons of bypass surgery

Bypass surgery, whether it's coronary artery bypass grafting (CABG) or bariatric surgery, has both advantages and disadvantages.

Starting with the pros, performing a coronary artery bypass surgery in high risk patients has been shown to improve survival rates. The risk of death is lower after the operation than before it in these individuals [10]. With the technological advancements the procedure was improved, and the chances of a successful surgery increased [11].

Bariatric surgery, on the other hand, is considered the most effective treatment for obesity in terms of maintenance of long-term weight loss and improvement in obesity-related comorbid conditions [12]. Around 90% of people who undergo bariatric surgery lose a remarkable 50% of their excess body weight [13]. It also significantly reduces the risk of obesity-related conditions such as type 2 diabetes, hypertension, heart disease and stroke[13].

However, there are also cons to consider. For coronary artery bypass surgery, risks include bleeding, arrhythmia, blood clots, chest pain, infection, kidney failure, heart attack, or stroke [11]. Obesity is also a risk factor for occurrence of adverse events following cardiac surgery [14].

For bariatric surgery, risks include surgery-related complications and side effects, and many people require follow-up interventions, surgeries, and hospitalizations within 5 years of surgery [13]. It can also affect nutrient absorption, which over time may lead to health problems such as anaemia and osteoporosis [13].

Jakub Gwiazdecki

Jakub Gwiazdecki

Jakub is in his fifth year as a medical student at Comenius University in Bratislava, Slovakia. He has special interested in cardiology and in patient-centered medicine. His love for heart health isn't just book-smarts; he wants to know how it works, what it means for our feelings, and how key it is for health and happiness. Jakub thinks real good health care comes from always putting the patient at the centre, treating each person as a whole.