Heart disease: what are coronary angioplasty, stents and bypasses

In some cases, in addition to angioplasty, it may be necessary to implant a stent, a small metal tube-like mesh that, once extended, will be adhered to the wall of the vessel in order to dilate it so that the blood can flow.

Coronary problems are those involving poor blood and oxygen supply to the heart, resulting from obstructions in the heart arteries, the coronary arteries.

It will be necessary to intervene to restore blood flow by means of myocardial revascularisation.

Until the early 1970s, only bypass surgery was used; angioplasty took over with the advent of new technologies and less invasive procedures, which did not require general anaesthesia but could be performed under local anaesthesia.

The coronary angioplasty procedure involves inserting a wire into the radial artery of the wrist, and no longer from the femoral artery as in the past, which will be run to the coronary artery.

A metal wire will be inserted, which will be run to the obstruction, and a balloon will be run on that wire until it is positioned in the area of the obstruction.

The balloon will then be inflated and a further balloon with a metal stent on top will be placed.

The second balloon fitted with a stent will also be inflated, which will open and allow the vessel to remain open; a stent is a microscopic metal prosthesis, the purpose of which is to keep a vessel open at a blockage that may have formed within it, and which slows down and risks blocking the blood flow.

Angioplasty will be used when blockages affect short sections of individual coronary arteries; it is an operation with minimal invasiveness and which provides long-term results.

If, on the other hand, the three main branches or several segments are involved, bypass surgery will be used.

In cases where both procedures can be used, the choice will be made by cardiologists and cardiac surgeons based on what the risks and benefits might be for the patient concerned.

The angioplasty procedure lasts between 15 and 60 minutes, depending on the complexity of the case.

It will be performed under partial anaesthesia, although in exceptional cases it may be necessary to use general anaesthesia.

Coronary artery bypass surgery consists of creating a sort of vascular bridge, after removal of a mammary artery or saphenous vein branch, in order to bypass the obstruction and/or narrowing of the coronary arteries so as to restore blood flow to the myocardium.

Coronary artery bypass surgery is an operation that is performed in the open heart following thoracotomy; it is much more invasive than angioplasty but will allow intervention where there is severe occlusion and a large number of obstructed coronary arteries.

Following the operation, it may be necessary to resort to pharmacological treatment because, as the stent is a foreign body, it will be necessary to wait for it to be covered by the vessel tissue.

During this time, anti-platelet agents will be used to inhibit the platelets and their aggregation; aggregation that could cause a clot in the very area where the stent is grafted.

In addition to antiplatelet agents, aspirin could also be administered, but in low dosages.

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