It has the following disadvantages:
- The blood vessels can close up (restenosis) so that patients require additional procedures. (New blood thinning drugs, coronary stent coatings, and radiation treatments may help to significantly reduce restenosis rates.)
- It is not as appropriate as bypass for many patients with angina (people with diabetes, elderly patients, or those with multi-vessel blockage). Increasingly, however, angioplasty is proving to be as safe and as effective as bypass in many high-risk patients. Even if the doctor recommends bypass, patients should discuss the risks and benefits of angioplasty if they would prefer it.
Considerations for Choosing Bypass. Bypass is usually the appropriate procedure in patients with high-risk conditions, such as:
- Multi-vessel blockage. (In one report comparing surgery to angioplasty in patients with two or three blocked vessels, the mortality rate 1 year after bypass was 0.8% and after angioplasty was 2.5%. About 80% of patients in the study were men.)
- Diabetes. (Bypass produces significantly higher survival rates in these patients. Some experts believe angioplasty should rarely, if ever, be used in this population.)
- Being elderly.
- Certain structural features, such as a left main artery narrowed by 50% or more or a very long diseased portion of the artery.
Considerations for Women. Studies have reported higher mortality rates in women than in men after any heart surgery. Some experts theorize that on average women may be older and sicker when they have a heart operation. A 2002 study, however, suggested that when women with acute coronary syndromes are given the same aggressive and early treatment as men are, their survival rates are equal or even better.
Other Procedures
In addition to angioplasty and bypass procedures, a number of other procedures are available or under investigation for coronary artery disease. They include:
- Atherectomy
- Myocardial Laser Revascularization
- Enhanced External Counterpulsation (EECP)
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