If you develop cardiovascular disease, you may eventually need a revascularization procedure. The term revascularization simply means to restore blood flow to the heart or another organ after the arteries have become clogged with cholesterol plaque. In the case of the heart, this can be accomplished either coronary artery bypass (CABG) surgerywith or angioplasty and stenting. Angioplasty and stenting are minimally invasive catheter procedures that together are known as PCI (percutaneous coronary intervention).
Revascularization for Coronary Artery Disease (CAD)
Whether people with diabetes fare better with CABG surgery or PCI is an ongoing controversy. That's because there haven't been many clinical studies that focused specifically on how to treat narrowed coronary arteries in people with diabetes. In addition, cardiovascular disease is different - and more severe - in people with diabetes. For example, people with diabetes often have widespread atherosclerosis affecting many arteries, not just a single blockage. Plaque deposits are often longer and affect smaller blood vessels in patients with diabetes. And after an angioplasty procedure, it is more common in people with diabetes to find that the artery has become obstructed again, this time by an overgrowth of scar tissue. Known as restenosis, this complication explains why patients with diabetes are more likely to need repeat procedures after angioplasty and stenting when compared to non-diabetic patients.
For many years it was believed that CABG was the best choice for people with diabetes, mostly because early studies showed that long-term survival was better with surgery than with PCI. But more recent studies have started to change the way people think. Now that drug-eluting stents are available, many interventional cardiologists believe that angioplasty and stenting is a good option for certain people with diabetes, depending on how widespread the coronary artery disease is and how complex each cholesterol plaque is.
Revascularization for Peripheral Artery Disease (PAD)
If you have peripheral artery disease (PAD), treatment will include medication and lifestyle changes, just as with coronary artery disease. Getting more exercise and quitting smoking are especially important. Depending on how severe your PAD is and how you respond to initial therapy, you may also need revascularization to make sure your legs and feet are getting enough blood flow. Whether the best treatment is surgery or a minimally invasive catheter procedure will depend on the specific type of blockage and which artery is involved.
Revascularization for Carotid Artery Disease
You may also need revascularization because of plaque build-up in a carotid artery, which supplies blood to the brain. For now, most patients are treated with a surgical procedure known as carotid endarterectomy (CEA).This procedure involves opening the artery, cutting or scraping away the plaque and removing it.
However, for years, researchers have been conducting clinical studies to determine which types of patients and which types of plaques could be safely and effectively treated with a minimally invasive catheter procedure known as carotid artery stenting (CAS). Growing evidence supports the use of CAS in an increasingly wide range of patients with carotid artery disease, though not in all patients. Recommendations and guidelines are being revised on an ongoing basis as new evidence becomes available.
The bottom line is, whether you have heart disease, PAD, or carotid artery disease, the choice between surgery and catheter-based interventions like angioplasty and stenting must take into account your medical history and individual preferences, and should be made after a careful discussion with your physician.