Introduction
Cardiac diseases affect millions of individuals worldwide and are a global health concern. They include various conditions that affect the normal functioning of the heart. Coronary arteries are the major blood vessels that supply oxygen-rich blood to the heart. Coronary artery disease (CAD) occurs due to plaque accumulation (cholesterol deposits) along the walls of the coronary arteries, resulting in a blockage or narrowing of the arteries. An unhealthy diet can cause it, lack of physical activities, obesity, smoking tobacco, stress, and other factors. Angioplasty and bypass surgery are two common surgical methods recommended to treat coronary artery disease. Both these procedures differ in their approach but are targeted to improve the blood supply to the heart. However, the doctor decides the best option after assessing the patient’s condition and analyzing the risks and benefits.
How Is Coronary Artery Disease Diagnosed?
A healthcare specialist can diagnose coronary artery disease based on the patient's complete medical history, signs and symptoms, and certain diagnostic tests and imaging. Coronary artery disease can cause nausea, shortness of breath, chest pain (angina) or discomfort radiating to the arms or shoulder, cold sweats, weakness, and other symptoms. Blood tests are recommended to check glucose, cholesterol, lipoproteins, and triglyceride levels. Some of the imaging tests to diagnose coronary heart disease include an electrocardiogram (ECG) to monitor the electrical signals, cardiac magnetic resonance imaging (MRI) to detect tissue damage and blood flow, stress tests to monitor the functioning of the heart, coronary calcium scans to measure the calcium deposited on the walls of the arteries, coronary angiography to check the blood flow and detect blockages, and a cardiac positron emission tomography scan (PET) to assess the blood flow to the blood vessels and the heart muscles.
How Is Coronary Artery Disease Managed?
The treatment for coronary heart disease depends on the symptoms, diagnosis, severity of the condition, and general health of the patient. Lifestyle changes and medications such as statins, calcium channel blockers, nitrates, omega-3 fatty acids, and other medicines for weight management are recommended for mild cases of coronary artery disease. However, surgery may be necessary in severe cases of coronary artery disease. These include:
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Coronary Artery Bypass Grafting (CABG): It is also known as bypass surgery. It is a surgical procedure in which a blood vessel is taken from another part of the body and attached (grafted) above or below the blocked area to create a new path (bypass) for blood flow to the heart. This reroutes the blood flow around the blocked coronary artery and improves the functioning of the heart. It helps to treat severe blockages in multiple coronary arteries.
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Coronary Angioplasty: It is also known as percutaneous coronary intervention (PCI). During this procedure, a flexible tube known as a catheter is inserted into a blood vessel by a small incision in the arm, wrist, or groin. A deflated balloon is fixed to the tip of the catheter. Once the catheter is at the blocked blood vessel, the balloon is inflated, which compresses and squashes the plaque, widens it, and opens the clogged arteries, improving the blood flow. A tiny metal wire mesh called a stent and certain drugs may be placed in the artery, which helps keep the artery open and lowers the risk of frequent narrowing.
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Other Treatments: These include laser revascularization (for severe angina), bariatric surgery (to reduce the risk of coronary heart disease), and heart transplantation (for severely damaged heart tissues).
Which Is Better, Angioplasty or Bypass Surgery for Coronary Artery Disease?
The choice between angioplasty and coronary bypass surgery can be quite challenging. The surgeon typically prefers depending on the reports of the diagnostic tests, severity or the extent of the condition, and coexisting medical conditions. The surgeon also considers the opinion of the patients or the caregivers before concluding.
Angioplasty is a minimally invasive surgical technique and is most commonly recommended for limited blockage or uncomplicated cases of coronary artery disease. It may not completely remove the fatty deposits but rather widens the arteries to improve the blood flow to the heart. Without inserting a stent, the artery may undergo narrowing again in 30 to 40 percent of cases. However, a stent may reduce the rate to about 10 to 20 percent. If a drug-eluting type of stent is inserted, patients must take medications for over a year to prevent clot formation around the stent. Though the success rate of angioplasty is high, it may not be preferred in all cases of coronary artery disease. However, it is a simple procedure compared to the bypass surgery and has a faster recovery rate. The complications following the procedure are minimal, and the cost is affordable for most patients. A hospital stay may be required for one or two days, after which the patients can resume routine activities.
Coronary bypass surgery is conducted under general anesthesia, and a hospital stay is required for around four to seven days, depending on the overall recovery of the patient. This procedure is usually recommended in cases of narrowing of the main coronary artery or multiple coronary arteries and the presence of severe calcification to support a stent. In comparison to angioplasty, bypass surgery is more invasive and can be associated with complications such as infections, bleeding, and blood clots. It requires several weeks or months for recovery. However, patients need not take blood-thinning medications; the relapse is minimal as the arteries remain wide open for a longer period and provide a better blood supply to the heart. It is also known to reduce the symptoms and improve the quality of life.
What Are the Recent Developments in Angioplasty and Coronary Artery Disease?
Coronary angioplasty may be associated with a complication called restenosis. It is a condition when the treated artery becomes narrowed again. If it occurs after the implantation of a stent, it is called in-stent restenosis. Intracoronary radiation or brachytherapy is a recently developed technique known to be effective for in-stent restenosis. It involves balloon angioplasty of the restenosis segment, followed by an irradiated catheter for a few minutes. This reduces the tissue growth within the stent and the risk of restenosis. Drug-eluting stent (coated with medication) is also a breakthrough in preventing in-stent restenosis and scar tissue formation.
The minimally invasive direct coronary artery bypass technique (MIDCAB) is a technique developed to overcome the invasiveness of CABG. The surgeon need not incise through the breastbone but requires only a small incision between the ribs to treat the clogged artery. MIDCAB does not require a heart-lung machine, as a stabilizing device is used to function the heart during the procedure. However, it also requires a hospital stay of about three days and cannot be used for more than two blocked arteries.
Conclusion
The modern treatment of coronary artery disease started with the development of bypass surgery a few decades ago, which was followed by angioplasty. Bypass surgery is a highly invasive procedure but provides excellent long-term revascularization. Angioplasty is a minimally invasive technique. However, the effects are tempered by conditions such as restenosis. Recent advances have been made to reduce these drawbacks and improve the functioning of the heart. The healthcare specialist determines the treatment choice depending on the severity of the condition and the patient's general health. However, regular checkups and a healthy lifestyle are recommended to prevent chronic diseases.
