In more severe cases of heart disease, surgical procedures may be required to reestablish an adequate flow of blood to the heart muscle. There are a number of surgical techniques that can be applied for revascularization.

Different Stages of Heart Disease
May Require Different Surgical Procedures

Coronary artery bypass graft
When blood vessels in the heart are severely clogged, it may be necessary to “reroute” the blood stream. This common surgical procedure clears the way for blood to reach the heart muscle by bypassing a blockage. To achieve this, a blood vessel is usually removed from the patient’s leg and then sewn into a place in the heart to build a detour around the blocked artery.

Angioplasty
Percutaneous transluminal coronary angioplasty (PCTA), or abbreviated, angioplasty, uses a balloon-tipped catheter to re-open clogged blood vessels. The device is inserted into an artery near the blocked blood vessel and then maneuvered toward it. Once the blockage is reached, the small balloon is inflated, which opens the blood vessel by flattening the clogging plaque against the blood vessel wall. Once the catheter is removed, blood can again flow more freely. Angioplasty alone does not always clear blood vessels permanently. That is why the procedure is often followed by the installation of coronary stents, which are small devices that can hold blood vessels open.

Coronary stents
A stent is small cage-like structure made of stainless steel. Because it is collapsible, it can be reduced in size enough to be inserted and threaded through the arteries. Once the stent is maneuvered inside a blocked vessel in the heart, it is expanded and left permanently in place to keep the vessel open and permit normal blood flow. This procedure is better suited to reduce the risk of re-clogging of the arteries than angioplasty alone.

Atherectomy
Atherectomy is technically similar to angioplasty. Again, a catheter is inserted into a clogged blood vessel. Instead of a balloon-like device to open the vessel by widening it, a rotating metal blade is attached to the catheter. Plaque then is removed from the vessel wall by the rotating blade. Newer versions of this procedure have replaced the blades with laser technology.

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