Q: What are the indications and contraindications of angioplasty and bypass surgery? Which one is better - angioplasty or bypass?

A:The decision to choose between angioplasty and bypass surgery is always a combined decision taken by the cardiologist, cardiac surgeon and the patient himself and there are a lot of grey areas where either form of treatment can be advocated. Therefore, there are no hard and fast indications and contraindications of angioplasty or bypass surgery. Having said this, generally, if a patient has localised block in one or two arteries, especially if it does not involve a side branch or if it is not heavily calcified, then angioplasty is a better option. However, if the blockages are multiple and involve a number of arteries subtending a large area of the muscle of the heart or if the blockages are heavily calcified or involve a side branch or involve a tortuous segment of the artery, then bypass surgery is a better option. Also, in a diabetic patient, the results of bypass surgery are superior to those of angioplasty. Left main artery blockage also calls for coronary artery bypass surgery. These are anatomical factors, which help in deciding, whether to go for bypass or angioplasty. Besides this, one has to look at the patient’s financial status, his or her preferences and his or her proximity to medical facilities for a regular follow up. In general, angioplasty is costlier than bypass surgery and requires a more intensive follow-up programme than bypass surgery. However, to the advantage of angioplasty, the hospital stay is shorter and return to gainful employment is faster. The recurrence rates are marginally higher with angioplasty as compared to bypass surgery. So all these factors are taken into account before one makes a decision for angioplasty or bypass surgery.