Contributor: Samar Kapadia, MD
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When patients have a blockage in their arteries, they tend to favor the idea of a surgeons performing percutaneous coronary intervention (PCI) over a full-blown surgery — or coronary artery bypass grafting (CABG).
Percutaneous means that surgeons are going through the skin, typically with a tube from the groin area. Instead of the large incision required for traditional heart or vascular surgery, percutaneous approaches use special catheters and devices to treat the problem through one or more small puncture sites through the skin. Surgeons guide that instrument up to the heart, and then open the blockage.
Percutaneous procedures mean very small incisions and a much quicker recovery time. Even better, they may offer options for some patients who cannot undergo conventional surgery because of poor heart function or additional medical problems.
CABG is open-heart surgery. In this procedure, surgeons bypass one or more blocked coronary arteries with a blood vessel graft. These grafts usually come from the patient’s own arteries and veins located in the chest, leg or arm.
The goal is to restore normal blood flow to the heart. The graft goes around the blocked artery (or arteries) to create new pathways for oxygen-rich blood to flow to the heart.
Not two options
PCI and CABG should not be thought of separately in terms of treatment.
They should not be considered two options, with either one or the other to treat arterial blockages. Rather, they are complementary techniques.
Of course, no one wants to have open heart surgery, and you should avoid it when you can. But for some cases, surgery is simply necessary for the best outcome.
For someone with limited coronary disease, PCI is a good option. But for someone with disease that affects multiple vessels, the prognosis is better with CABG. This lessens the risk of death and heart attack.
Collaboration
You want to obtain opinions by a cardiologist and heart surgeon and formulate the best plan that is specific to you.
For example, at Cleveland Clinic, surgeons work together to find the best treatment for each patient. So when a patient comes in to see a cardiologist or sends in records to determine if they are a surgical candidate, a cardiologist and heart surgeon review the information.
Together, they find the best treatment course. This may be PCI, surgery or medical therapy. They consider all the options to find the best options for the patient.
