Angioplasty VS Coronary Artery Bypass Grafting (CABG)

Coronary Artery Disease

Coronary arteries are the major arteries in the human body which supply oxygen rich blood for the proper functioning of the heart. Sometimes a cholesterol rich diet causes accumulation of plaque (fatty deposits) on the inner wall of the coronary arteries. With time these deposits cause blockage, narrows down the artery and hinders the blood flow to the heart muscles. This condition is generally termed as atherosclerosis and can lead to heart attack, stroke, and heart failure. All the symptoms and conditions arising out of atherosclerosis is called Coronary Artery Disease (CAD) or Coronary Heart Disease (CHD). A person can develop these blockages in one or multiple arteries of the heart (also known as multi vessel CAD or complex CAD). This condition is generally treated by removing the blockages and widening the arteries so that normal flow of the blood to the heart can be restored.

Diagnosis of Coronary Artery Disease (CAD):

People suffering from coronary artery disease may develop angina or mild chest pain. Doctors at Yashoda Hospitals and Research Centre Nehru Nagar Ghaziabad may ask for an electrocardiogram test also known as ECG to find the exact reason for the reduced blood flow in the coronary arteries. If CAD is suspected then the patient may be asked to go through a treadmill stress test or pharmacological stress test to rule out or confirm Coronary Artery Disease.

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Treatment option for Coronary Artery Disease (CAD):

Here are some of the treatments used to treat Coronary Artery Disease (CAD):

• Medical Therapy: The doctors generally recommend this to the patients with one or two minor blockages so as to reduce blockage by using medications, changes to the diet, quit smoking, and by following proper regular exercise. When this therapy does not work then the patient must be treated with medical interventions such as angioplasty or CABG.
• Balloon Angioplasty with Stenting: This procedure is performed by making an incision in the groin, arm, or leg area and a tube (catheter) is inserted into the blood vessel through the incision and gently pushed to the heart or at the site of blockage. The catheter has a deflated balloon fixed at one end which is inflated to push the stent against the deposits. After placing the stent at the desired location the balloon is deflated and removed along with the catheter. With time, the stent gets surrounded by healthy tissues which hold the stent in its place.
• Coronary Artery Bypass Grafting (CABG): In this procedure a piece of blood vessel (graft) is taken from another body part such as from the chest wall (mammary glands), the arm (radial artery), or from the lower leg (saphenous vein) etc. is stitched above and below the blocked artery so as to reroute the blood flow around the blockage.

Comparing Angioplasty and Coronary Artery Bypass Grafting (CABG):

Coronary Artery Bypass Grafting (CABG):

• Type of procedure: It is a surgical procedure performed by making an incision through the sternum to access the blocked artery. Lung heart machine is used in this procedure which maintains circulation of the heart and is performed under general anesthesia.
• Suitability: CABG is inevitable in patients who have blockage in the left anterior descending (LAD) artery, one of the three main coronary arteries stenting will not work. CABG may be the only option for the patients suffering from diabetes, kidney disease, heart valve disease, peripheral arterial disease, a prior heart attack or stroke.
• Hospitalization: A person might stay in the hospital for 3-5 days post procedure.
• Recovery time: It may take around 3 to 6 months for a patient to resume everyday life depending on the age, number of the blockage removed, and other health conditions.
• Post procedural treatment: Patients have to make lifestyle changes post surgery.
• Need for a repeat procedure: According to a study published in The New England Journal of Medicine in January 2008, patients who had stenting or CABG in the U.S. in the years 2003 and 2004 are compared and suggested that only 5.1 percent of the patients who had a CABG need a repeated procedure.
• Cost: The cost of the procedure and CAD related treatment for the rest of the patient’s life is lower for CABG than stenting. Hospitalization costs might be higher due to prolonged stay at the hospital.

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Angioplasty:

• Type of procedure: Angioplasty with stenting is a minimally invasive surgical procedure performed without anesthesia.
• Suitability: Stenting is generally preferred in patients with less number of blockages, has a healthy BMI and does not have co – morbidities. Elderly patients with or without co- morbidities are always advised for stenting.
• Hospitalization: A person undergoing this procedure is observed for a night at the hospital and then discharged the next day.
• Recovery time: A person can get back to his or her normal life within a week post surgery.
• Post procedural treatment: Patients are required to take medications such as clopidogrel and aspirin after they have undergone drug eluting stenting for almost a year post surgery. These drugs will prevent the formation of blood clots around the stent.
• Need for a repeat procedure: : According to a study published in The New England Journal of Medicine in January 2008, patients who had a stent and who needed a repeated procedure within 18 months were as high as 30.6 percent.
• Cost: The cost of the procedure and CAD related treatment for the rest of the patient’s life are higher for stenting. Hospitalization costs might be lower due to shorter stay at the hospital.

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Choosing Between Angioplasty and Coronary Artery Bypass Grafting (CABG):

It is quite difficult to choose between CABG and stenting. In many cases hospitals may ask the preference of the patients while in other cases there is no choice. Sometimes cardiologists maintain a score card by evaluating a patient’s   health condition and on this basis they may suggest a better treatment by designing a better course of treatment for speedy recovery and rehabilitation.

Meet the specialists at Yashoda Hospital & Research Centre, Nehru Nagar, Ghaziabad

Dr. Yatin Arora is a Senior Consultant, Cardiothoracic & Vascular Surgery at Yashoda Hospital, Ghaziabad. He has 10+ years of experience in Cardiovascular & Vascular Surgery. Dr. Arora’s expertise lies in Adult cardiac surgery,  Mitral valve replacements, Coronary artery bypass grafting (CABG) etc.

Dr. Ankur Agrawal is a highly skilled and accomplished Cardiothoracic & Vascular Surgeon working as Consultant at Yashoda Hospital, Ghaziabad. Being trained from the most prestigious institute of India, AIIMS, New Delhi, he specializes in all types of adult & pediatric cardiac surgeries as well as thoracic and vascular surgeries.