Narrowed arteries can frequently be reopened with one of two treatments: stenting or bypass surgery. Because these atherosclerosis treatments come with risks, they are typically reserved for emergencies or when medications fail.
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1. Angioplasty and Stenting
A coronary angiogram is a special X-ray test that doctors use to identify coronary artery blockages and sometimes take action to open them up. In an angioplasty, a doctor first introduces a catheter (a narrow tube) into an artery in the leg or arm. The catheter is then moved to the area of concern. Usually this is the coronary arteries in the heart, or the arteries in the legs or brain.
By injecting dye that is visible on live X-ray screens, the doctor can see blockages in the arteries. Using tiny tools on the catheter tip, he or she can often open blockages.
A stent is a tiny cylinder of wire mesh. During an angioplasty, a balloon on the catheter tip is inflated inside a blockage to open it. Stents can be placed during this process and are left behind once the balloon and catheter are removed.
Stents can relieve chronic symptoms of chest pain (angina), or reopen a blocked artery during a heart attack.
Coronary angioplasty with stenting has a low complication rate. The recovery time is often less than one day.
2. Coronary Bypass Surgery
In bypass surgery, a surgeon "harvests" a segment of a blood vessel from the leg, arm, or chest. He or she sews this healthy vessel onto the coronary artery, rerouting blood around the clogged artery.
Coronary artery bypass surgery -- or CABG (pronounced "cabbage") -- is the most commonly performed bypass surgery. CABG can provide relief from chest pain caused by atherosclerosis. Bypass surgery also leads to increased survival in people with multiple or severely blocked coronary arteries.
As you would guess, CABG is major surgery. Although low overall, the risk of serious complications is similar to coronary stenting. The recovery time can take weeks, even months. Newer less-invasive forms of CABG, with shorter recovery times, are under evaluation.