Angioplasty and Stenting or Bypass surgery is advised when a patient is suffering from coronary artery disease (CAD). It is a disease caused due to hardening of the coronary arteries. Also termed as atherosclerosis, the arteries on the surface become so hard that they lead to death in both men and women.

Normally, the artery walls are smooth and flexible from inside allowing easy blood flow through them. When plaques or fatty deposits build inside the arterial wall, they narrow the artery thereby either reducing or completely stopping the flow of the blood.

Treatment of Coronary Artery Disease

If the doctors suspect a patient of having CAD, he advises coronary angiography.

Depending upon the angiography guide, the options such as medical therapy, coronary artery bypass surgery or angioplasty and stenting is advised. The decision largely depends on the severity of the disease.

In many conditions, if the coronary narrowings are not limiting the flow of the blood doctors advise medications and lifestyle modifications to prevent further progression of the disease.

However, in case the blockages prevent the arterial blood flow, doctors usually advise balloon angioplasty and stenting.

"Patients with multiple blockages in the arteries coronary artery bypass graft surgery are recommended"

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Best Option

Angioplasty and Stenting

According to a study, roughly one-third patients with CAD undergo angioplasty and stenting. The procedure is carried out in a cardiac catheterization laboratory wherein the same type of catheter is used for diagnostic coronary angioplasty.

While conducting balloon angioplasty, a catheter with a balloon at its end is pushed against the arterial wall so that the blood flow to the artery is improved.

In some cases, devices are used to cut the plaque and remove it from the arteries. Coronary stenting accompanies the angioplasty procedure more often. Stents are made up of small wire-mesh metal tubes that form scaffolding to support the damaged arterial walls.

It also reduces the chance that the vessel will shut again after angioplasty.No anesthesia is required for carrying this treatment. In some cases, the patients are given mild sedation. Although it is not an outpatient treatment, the patients can go home the same day after a couple of hours or the next day. 

Which Is Better: Angioplasty and Stenting or Bypass Surgery

The decision whether to choose angioplasty and stenting or bypass surgery entirely depends on the preference of the patient and the doctor. Also, other factors such as patient-specific characteristics including pre-history of heart failure, diabetes, may play a crucial role in selecting either of the procedures.

Most probably, angioplasty is considered when one, two or even three arteries are narrowed. However, it needs to be checked whether the arteries have enough strength to suit angioplasty.

On the other hand, when the arteries have narrowed significantly especially the left main coronary artery or all the three major arteries are narrowed, bypass surgery is the best option.

It is also preferred in case the patient is diabetic or has a history of heart failure or disease. In case, revascularization is considered a more economical option the doctors may suggest either angioplasty or bypass surgery.

The aim of both the treatments is to ensure that the blood flow to the heart is improved. In the past decade, the number of people opting for bypass surgery has decreased by one-third. And it is all due to the advancement in the development of drug-eluting stents used during the PCI.

"Drug-eluting stents come with a polymer coating that releases the drugs slowly over time and prevents recurrence of blockage"

The recovery time for angioplasty and stenting is quicker as compared to bypass surgery. However, angioplasty cannot be recommended to everyone suffering from coronary heart disease.

In diabetic patients, surgery is a better option. Similarly, the bypass is advised more to patients with the triple-vessel disease. On the other hand, patients with lesser coronary artery disease severity are advised angioplasty. 

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