Coronary revascularization procedures treat narrowed arteries to improve blood flow to the heart. Common types include percutaneous coronary intervention and bypass surgery.

If you have a condition that prevents blood from flowing to areas of your heart, like coronary artery disease (CAD), a procedure called coronary revascularization may help reduce the risk of serious complications, such as heart attack.

Coronary revascularization is a procedure that treats ischemia. Ischemia is cell damage from insufficient blood flow to the heart.

Reduced blood flow is usually due to atherosclerosis. This condition occurs when fatty deposits build up in the walls of the arteries, causing them to harden and narrow.

Coronary revascularization restores blood flow to the areas of your heart that need it.

According to 2021 guidelines, a doctor may recommend coronary revascularization for people with coronary artery blockages or narrowing, such as for the following conditions:

In some cases, such as for a severe heart attack, doctors may perform revascularization as an emergency procedure. But in other cases, such as for chronic or longstanding CAD, doctors may safely delay the procedure.

The guidelines note that in the past, women and non-white people — including African Americans, Hispanics, and South Asians — were less likely to have coronary vascularizations and other heart treatments in the United States, resulting in worse outcomes.

To address these inequities, the guidelines propose that recommendations for coronary revascularization be applied regardless of sex or race.

There are two main types of coronary revascularization procedures: percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG), also called heart bypass surgery.

Percutaneous coronary intervention (PCI)

PCI is a minimally invasive, nonsurgical procedure.

A cardiologist (a doctor specializing in cardiovascular conditions) restores blood flow to your heart by inserting a catheter inside a major blood vessel, typically in your upper thigh or wrist. The cardiologist then steers the catheter to your heart.

Cardiologists typically perform PCI using a technique called angioplasty. It involves using a catheter-tipped balloon to widen the blocked artery. This is almost always followed by stent placement, a small mesh tube to keep the artery open.

Coronary artery bypass graft (CABG)

To restore blood flow to a blocked artery, a surgeon constructs a bypass or pathway by removing a blood vessel from your arm, leg, or back and then inserting it around the artery.

There are two ways to access your heart for a CABG:

  • Open-heart surgery: In open-heart surgery, a surgeon makes a long incision down the center of your chest, cracks your breastbone, and then separates your ribs.
  • Minimally invasive surgery: After making small incisions in your chest, a surgeon uses special tools that can reach your heart through the spaces between your ribs.

In some cases, the surgical team may stop your heart during this procedure while a heart-lung bypass machine circulates your blood.

After open-heart surgery, the surgeon puts your ribs back in place, wires your breastbone, and sews up the incision.

For minimally invasive surgery, the surgeon removes the tools and stitches the incision.

Before coronary revascularization, a doctor may perform heart tests and imaging to see which arteries are blocked. These tests may include:

A doctor may discuss with you what to do before the procedure, such as:

  • medications to take and to stop taking
  • when to stop eating and drinking
  • bathing with a special soap that reduces the bacteria on your skin

Research shows that the outlook for people with severe heart disease may improve following coronary revascularization.

For people admitted to a hospital with a heart attack, coronary revascularization is a lifesaving procedure.

A 2020 study with 9,016 people with chronic stable CAD at high risk of heart attacks suggests that those who underwent coronary revascularization survived longer and with a lower risk of heart attacks than those who did not have this procedure.

In a 30-year study in Denmark with people who underwent CABG, about 70% survived more than 10 years after the procedure. However, the risk of dying from a heart attack, stroke, or heart failure was significantly higher in the 30 days following the procedure.

The following are answers to some frequently asked questions about coronary revascularization.

What is the best treatment for heart blockage?

The best treatment for restoring blood flow to your heart depends on several factors, such as the severity of your heart disease.

CABG, which creates a new pathway for blood flow, may be the best treatment for people with extensive CAD that affects multiple blood vessels. Noninvasive PCI, which opens a clogged artery, may be best for people with single-vessel CAD.

Other factors to consider include the nature of the heart blockage and your overall health. A doctor can help you determine your best treatment option.

Is revascularization the same as bypass surgery?

“Coronary revascularization” is an umbrella term that refers to restoring blood flow to your heart. It includes both coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI).

CABG restores blood flow by creating a new pathway to your heart.

Is revascularization the same as stenting?

Stenting is one of the techniques used to perform a percutaneous coronary intervention (PCI) to help restore blood flow to your heart. A surgeon inserts a stent, or small mesh tube, in the clogged artery to keep it open so blood can flow through it.

For people with extensive CAD, revascularization may increase survival rates and lower the risk of heart attacks.

The coronary revascularization procedure a surgeon performs — usually either a PCI or CABG — depends on several factors, such as:

  • the location, amount, and characteristics of the blockage
  • your ability to undergo surgery
  • the presence of other medical conditions

A doctor can talk with you about the best treatment for a positive outcome.