PTCA, or percutaneous transluminal coronary angioplasty, and CABG, or coronary artery bypass grafting, are procedures performed to treat coronary artery disease. Both methods can increase blood flow to the heart and improve symptoms such as chest pain or shortness of breath. Read on to learn more about PTCA vs CABG and which procedure may be best for you and your symptoms of coronary artery disease.
What is Coronary artery disease (CAD)?
Coronary artery disease (CAD) occurs when plaque builds up in the coronary arteries, causing them to narrow and reducing blood flow to the heart. If you have CAD, your doctor will consider several different options based on your symptoms and the severity of your disease. One of the most common treatments is PTCA (often called angioplasty), which uses a balloon to open narrowed arteries and allows more blood to flow through them. The other is CABG, an open-heart surgery where grafts are used to establish blood flow.
Anxiousness is quite common when you have to choose PTCA vs CABG.
It’s not uncommon to feel anxious when you find out that you have coronary artery disease or CAD. You may have had an angiogram and learned that you have several narrowed or blocked arteries in your heart, and now you have to decide which treatment option is best for you. Fortunately, many treatment options are available to address your CAD, including percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG). Here are the key considerations in choosing between these two standard treatment options for CAD.
PTCA vs. CABG for coronary artery disease: Which is best for you?
Determine if either procedure can fix your problem
The decision to opt for PTCA or a bypass surgery depends on several factors, including the severity of your symptoms, location, the extent of damage to your arteries, other medical conditions, and overall health status. Your doctor will weigh all these elements when determining which procedure would be most beneficial in treating your condition. You’ll also need to consider whether you have any additional medical conditions or physical limitations that may complicate either option or make one completely inappropriate for your situation.
Understand the risks and benefits of each procedure
To decide which of these procedures is best for you, understand each procedure’s risks and benefits. Risks with CABG over higher over the short term, but CABG is better than PTCA in the long run.CABG is significant surgery with more risk and prolonged hospital stay. The risk of bleeding, infections, and brain stroke is common compared to PTCA. Whereas PTCA takes less time and requires a shorter hospital stay than CABG does; however, with PTCA, you have a slightly higher risk of repeat blockages in the future. With PTCA, all kinds of blockages can not be opened. Also, note that PTCA can require subsequent CABG procedures if angioplasty doesn’t unblock clogged arteries.
Risks with CABG: CABG is associated with a higher rate of early brain stroke, infection, and bleeding
Risks with PTCA: PTCA is associated with a higher rate of reblockages in the future. The risk of death is higher at five years with PTCA compared to CABG.
Know about the anatomy of your coronary arteries
It’s essential to look at your risk factors and medical history and talk with your doctor about what makes sense. For instance, if you have more than two blockages or your arteries are severely hardened (which can increase complications with PTCA), then PTCA may not be an option for you, and CABG would be a better choice.
Know what’s involved in each procedure
Before deciding whether to have PTCA or CABG, it’s essential to know what each procedure involves—and which one could be best for your situation. PTCA is a minimally invasive surgery with no scar, no general anesthesia, no ventilator support, and quick recovery. CABG is done by opening the chest, which leaves a long scar and needs a long time to heal. Slow recovery, prolonged hospital stay, and the need for general anesthesia and ventilator are involved in CABG.
What doctors are involved in CABG and PTCA
Cardiologist Perform PTCA whereas CT surgeons do CABG.
Where are CABG and PTCA performed?
PTCA is performed in a cath lab whereas CABG is done in a major operation theatre (OT).
Cost of CABG and PTCA in Hyderabad?
The cost of PTCA varies and can range from one lakh to 10 lakhs. Similarly, CABG costs from 2 lakhs to 6 lakhs.
Understand how the two procedures are different
Both PTCA and CABG treat coronary artery disease or a blockage in the arteries to your heart. Both have different risks and recovery times but both increase life expectancy.
Both procedures are intended to open up blocked arteries and reduce your risk of heart attack, stroke, or death from coronary artery disease (CAD). Each procedure has pros and cons. To decide which surgery would be right for you, consider how well your body tolerates surgery.
Choose the Procedure That Best Fits Your Needs
Your doctor may first suggest that you try medication to treat your condition instead of an invasive surgical procedure like PTCA or Coronary Artery Bypass Grafting (CABG). If medicines don’t prove effective, your doctor may recommend you consider getting a stent or CABG. Heart stent surgery is also known as percutaneous coronary intervention (PCI) with stenting. Coronary artery bypass graft surgery is also known as CABG.
Factors that decide the best treatment among PTCA vs. CABG
Every patient is different. The exact size does not fit all. Every patient has a different number of blockages, a different risk profile, different complexity of the lesion, and different heart function.
Influenced by several factors, including the number of vessels involved, the amount of myocardium supplied by the affected vessels, the complexity of the blockage, the likelihood of tackling all the major blockages, and patient comorbidities such as diabetes, and patient preference.
Number of blockages
- Single vessel disease or SVD
- Double vessel disease or DVD
- Triple vessel disease or TVD
- Left main disease or LM disease
In general, PTCA is better for the first two, and CBAG is for the next 2.
Artery involved
- Left the main artery or LM
- Left anterior descending artery or LAD
- Left circumflex artery or LCX
- Right coronary artery or RCA
PTCA is better for the last three, and CBAG is for the first.
Type of blockages
- Simple lesion
- Complex lesion
- Intermediate lesion
Complex lesions are difficult to stent and may need CABG. Simple lesions are often treated with PTCA.
How well your heart is able to pump blood through the body
- Good left ventricular function or strong heart
- Poor Left ventricular function or weak heart
Poor Left ventricular function or weak heart: Greater benefit with CABG
Comorbidities
- Peripheral vascular disease
- Lung diseases
- Kidney diseases
- Brain stroke
- Malnutrition
Higher the number of comorbidities, the greater the risks with CABG. Them, considering PRCA is a good option.
Before choosing PTCA or CABG, the patient should be informed about periprocedural risks of death, stroke, and the need for repeat revascularization. Some patients remain fearful of open-heart surgery. Then PTCA is the only option.
Your doctor uses the various score to assess mortality risk with CABG. If you have high score of mortality, CABG should be avoided.
Types where PCI is always preferred (although exception possible)
- Single or double vessel diseases
- Simple lesion
- Lesion involving RCA, LCX
- More comorbidities
- Patient preference
Types where CABG is always preferred
- Triple vessel disease
- Left main disease
- Ostial disease
- Who cannot take blood thinners
- Failed prior PTCA
- Complex blockages that can not be opened with a PTCA
- Patient preference
Conclusion: PTCA vs CABG
- If you have the single-vessel disease, PCI with drug-eluting stents is preferable.
- If you have the two-vessel disease involving the right and circumflex coronary arteries, PCI with drug-eluting stents is preferable.
- If you have diabetes and the disease of the left anterior descending and either right or circumflex coronary arteries, CABG is slightly better than PTCA.
- If you do not have diabetes and have the disease of the left anterior descending and either right or circumflex coronary arteries, CABG or PTCA can be chosen.
- If you have the three-vessel disease, CABG is the best strategy.
- Multivessel disease + Relatively well-preserved heart function, low complexity coronary anatomy, and no diabetesPCI is preferable
- CABG is a better option if you have two- or three-vessel disease and are told that one of your blockages can not be opened with a stent.
- If you are not willing for CABG, ask your cardiologist to perform stent surgery for you.
- Suppose you are deemed unfit for CABG based on your comorbidities or poor functional status. In that case, PTCA can be considered irrespective of the complexity of the lesion and the number of lesions.
PCI may be needed in stages performed at separate times in such cases. Thus, the patient must be willing to return to the catheterization laboratory on several occasions.
At the time of decision making, the patient should be informed about the relative risks of death and stroke with each procedure. When PCI and CABG are equally better, the decision should be made jointly by the patient, cardiologist, and CABG surgeon.
Hybrid coronary revascularization or HCR: A combination of PTCA and CABG
Till now, we have discussed PTCA vs CABG. Now we will see if we get better results if we combine them optimally to get better results. Complete or near-complete revascularization using the combination of single vessel CABG to LAD and PCI of other significant coronary lesions. In HCR, LAD is grafted using minimally invasive direct CABG (MIDCAB); MIDCAB is applied to procedures that use alternative incisions to standard median sternotomy. HCR offers a relatively low risk of stroke