Harvard Heart Letter

Teamwork in angioplasty-bypass decisions

New guidelines clarify the ifs and thens, but the choice is yours.

The release of new clinical guidelines usually gets more attention from doctors than from the people they treat. But anyone with clogged heart arteries or at risk of developing them should know about the updated guidelines on using bypass surgery and angioplasty to deal with such blockages (Circulation, Dec. 6, 2011).

The guidelines deem angioplasty to be a "reasonable alternative" to bypass surgery for people with a blockage in the left main coronary artery (see illustration) — if their artery anatomy is conducive to angioplasty and if they have a high risk of complications from bypass surgery. The left main artery is crucial because it supplies all the downstream vessels on the left side of the heart, including those feeding the heart's main pumping chamber, the left ventricle. Bypass surgery remains the recommended approach for most left main blockages and in situations where blood flow needs to be restored to three or more vessels.

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