What's the difference between angioplasty and coronary bypass surgery?

Inflating balloon during an angioplasty procedure See more heart pictures.
Inflating balloon during an angioplasty procedure See more heart pictures.
3DClinic/Getty Images

Four words you never want to hear from your doctor: "Your arteries are blocked." After the initial panic wears off, you think about all the cheeseburgers you've eaten over the years. You picture every French fry as a crunchy and delicious little grim reaper. A thousand egg, bacon and cheese sandwiches mock you.

The good news is that coronary artery disease (CAD) is very common and you have options, both surgical and non-invasive. How common? One in three Americans suffers from some kind of cardiovascular disease [source: American Heart Association]. Nine million of these Americans suffer from angina -- discomfort in the arms, lower jaw or chest due to reduced blood flow to your heart. The flow is reduced because of blockage from the buildup of plaque on the artery walls due to many factors including poor diet, a lack of exercise, heredity and whether you're a smoker.


If you suffer from angina, check in with your doctor as soon as possible to schedule a coronary angiography. This test involves injecting your arteries with x-ray dye and watching the path of the colored substance as it makes its way through your blood vessels. The narrowed and blocked pathways are discovered, and you and your doctor know how severe your problem is and what kind of treatment is best.

If your arteries are partially or fully blocked, you have a couple of options. The first is called angioplasty and it's preferred by about one-third of all CAD patients. Angioplasty is a nonsurgical procedure where a tiny deflated balloon is inserted into the problem spot of the artery on the end of a catheter tube. When it reaches the scene of the crime, the balloon is gently inflated for a few minutes, then deflated and removed. This compresses the plaque and opens the passageway for better blood flow. Sometimes, a tiny metallic cage called a stent is put in place to keep the artery open.

The other option is a surgical procedure called coronary artery bypass grafting (CABG). A vein from the leg or chest is sewn to the artery, before and after the blockage, serving as a side street for the blood to flow around the plaque. For years, a patient needed to have his or her chest opened and heart stopped to perform the surgery. Although that method is still used, other minimally invasive techniques have been perfected using robotic arms to perform the procedure. The robot is operated by the surgeon, and the arms are inserted into the chest area through small holes, allowing the heart to continue beating.





Angioplasty or Coronary Bypass Procedures: Which is right for you?

The key stages in an angioplasty procedure: A catheter, stent and balloon are inserted into a blocked part of a coronary artery to open up the passageway.
The key stages in an angioplasty procedure: A catheter, stent and balloon are inserted into a blocked part of a coronary artery to open up the passageway.
3D4Medical.com/Getty Images

If you opt for an angioplasty procedure, you'll undergo a nonsurgical procedure that will have you up and on your feet sooner. An angioplasty only takes a couple of hours to perform and you'll remain under local anesthesia for the duration, which is appealing to many patients. You'll probably just need to stay in the hospital one night for observation, and then you're back home and in your normal routine within the week.

Coronary bypass surgery usually requires about week in the hospital and up to three months to fully recover. Minimally invasive micro-surgery procedures cut your recovery time down to a few weeks, with only three to four days in the hospital. You could be a candidate for this kind of operation if:


  • you have blockage in only one or two coronary arteries
  • your blocked arteries are on the front side of the heart
  • you're healthy aside from your artery blockage

There are also some restrictions for angioplasties. You probably aren't a good candidate if:

  • your blocked artery is too small for the balloon
  • your artery is completely blocked
  • your blockage occurs in the left main coronary artery
  • you have diabetes or have already suffered heart failure
  • your blockage is where two arteries meet

There are some other things you should consider when deciding between the two procedures. While angioplasty and bypass surgery have similar long-term outcomes and mortality rates, you're more likely to need a repeat procedure with an angioplasty. Sometimes the artery closes back up -- this is called restenosis. A 2008 study in Germany found that 14 percent of angioplasty patients needed another procedure within a year of the first. Only six percent of CABG patients required more work [source: ABC News].

Another study from 2007 gives us a more long-term picture. After five years, about 10 percent of bypass patients needed more treatment, and 46 percent of the angioplasty patients needed repeat procedures [source: The Washington Post]. One important thing to consider is that these stats are for angioplasties that don't use the metal stents. These tiny little pieces of arterial scaffolding have gone a long way in helping to shore up the interior walls of the blood vessels after the balloon is removed. And now there are drug-eluting stents. These stents are coated with time-released, blood clot-fighting drugs. For the 2007 study, the number of repeat procedures needed using the drug-coated stents fell from 46 percent to 40 percent [source: The Washington Post]. A study from 2005 concluded that long-term success rates with angioplasty alone was at 60 percent, using stents came in at 75 percent and using drug-coated stents hit the 90 percent mark [source: medicalmoment.org].

Although the last thing on your mind when dealing with life and death is cost, it's a factor for many people. A 2006 study found that at the five-year mark, costs for angioplasty were about 19 percent lower than with bypasses. This percentage equals almost $20,000 in savings [source: American Heart Association].

Determining which procedure to undergo is up to you and your family. Your doctor will recommend a course of action based on your condition and severity of the blockage, but it's up to you to understand the ins and outs of each procedure. Angioplasties are cheaper, less invasive and will have you on your feet sooner, but you're more likely to need another one at some point. CABG demands longer recovery time and will cost you more, but you may not need to go back in for follow-up procedures. If you have coronary blockage, get the facts, talk to your doctor and family, and you'll be able to make the best decision that fits your bank account and lifestyle. More than anything, start exercising and eating right, and your chances at living a long and healthy life will increase.


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More Great Links

  • "Angioplasty & Stents Combat Coronary Artery Disease." medicalmoment.org. Nov. 1, 2005. http://www.medicalmoment.org/_content/treatment/nov05/366479.asp
  • "Angioplasty more cost-effective than bypass surgery for some men." American Heart Association. Sept. 11, 2006. http://www.americanheart.org/presenter.jhtml?identifier=3041920
  • "Angioplasty Proves Reasonable Alternative to Bypass Surgery." revolutionhealth.com. March 31, 2008. http://www.revolutionhealth.com/articles/angioplasty-proves-reasonable-alternative-to-bypass-surgery/hd-614050?ipc=B00520
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