Coronary bypass and angioplasty are two procedures used to treat blockages or narrowing in your coronary arteries, the major blood vessels that supply your heart.

Doctors may perform angioplasty and coronary bypass as a preventive procedure or after a heart attack.

Read on to learn more about these two conditions, including the risks, what to expect during the procedures, and the recovery periods.

The purpose of an angioplasty or coronary bypass is to improve blood flow in your heart when you have a blocked or narrowed coronary artery.

These arteries are the vessels that supply your heart with blood. They can narrow due to the buildup of plaque. This buildup is called atherosclerosis.

Left untreated, atherosclerosis can lead to a heart attack. Coronary artery disease is the leading cause of death worldwide.

Bypass and angioplasty surgery both come with risks. Depending on the severity of heart disease and other factors, there’s some risk of death from both.

Other potential risks include:

Angioplasty risks

Risks of an angioplasty include:

Bypass risks

Risks of a coronary bypass include:

Here’s a look at the effectiveness of angioplasty and bypass procedures.

Angioplasty effectiveness

Angioplasty can improve blood flow through your coronary artery in most cases. Angioplasty with stenting is the treatment of choice for:

Angioplasty can be lifesaving after a heart attack.

Whether it improves the outlook for people with stable coronary artery disease (CAD) is controversial. Some recent evidence suggests it may not.

Bypass effectiveness

Research suggests that a coronary bypass may reduce death rates for up to 10 years compared with medications alone in people with reduced left ventricular function and inadequate blood flow to the heart.

People with CAD who receive a coronary bypass generally have:

  • higher survival rates
  • less angina
  • better quality of life

Here’s a look at the angioplasty and bypass procedures.

Angioplasty procedure

An angioplasty usually takes between 30 minutes and 2 hours. The steps are generally as follows:

  1. You are positioned on an X-ray table and given a local anesthetic and an intravenous (IV) line, which may deliver pain relievers, sedatives, or a contrast dye.
  2. A cardiologist makes a small incision in your groin, arm, or wrist to access an artery.
  3. A sheath is inserted into the artery to keep it open. A catheter is inserted into this sheath.
  4. A thin wire is passed through the catheter with a thin balloon until it reaches your coronary artery.
  5. The balloon is inflated for about 20–30 seconds to open your coronary artery.
  6. If you’re receiving a stent, the balloon puts it in place.

Bypass procedure

A coronary artery bypass usually takes 3–6 hours. The steps are generally as follows:

  1. You are given general anesthesia through an IV to put you asleep.
  2. A surgeon makes an incision along your sternum and spreads open your rib cage.
  3. Your heart is stopped with a medication. You are connected to a machine to take over the function of your heart and lungs.
  4. The surgeon takes a blood vessel from your leg, chest, or arm. You may need to have multiple grafts taken.
  5. The surgeon uses this blood vessel to create a bypass around your blockage.

Sometimes, a coronary bypass can be done without the need to stop your heart.

Here’s how you can prepare for your procedure:

Angioplasty prep

For nonemergency surgery, your doctor may tell you to stop taking blood thinners in advance.

Bypass prep

The recovery period is long after a bypass. You can prepare by:

  • arranging a drive home from the hospital
  • stocking up on easy-to-prepare food
  • arranging for help for about 2 weeks
  • preparing your home in advance to support mobility and comfort

Here’s a look at the recovery timelines for angioplasty and bypass procedures.

Angioplasty recovery

You may stay in a hospital overnight or go home on the same day. Most people who receive a nonemergency coronary angioplasty can return to work in about a week.

Bypass recovery

You’ll likely need to stay in the hospital for about 7 days after your procedure. Most people make a full recovery within 12 weeks.

Insurance providers, including Medicare, mostly cover coronary bypass and angioplasty.

Cost depends on your region. For example, the nonprofit FAIR Health estimates that 80% of coronary bypasses involving one graft are under $20,913 in New York City or $6,358 in Little Rock, Arkansas, without insurance.

The nonprofit estimates that 80% of coronary angioplasties of a single artery cost under $3,206 in New York City or $2,824 in Little Rock.

You may have additional costs, such as hospital and anesthesia fees.

Other treatment options for CAD include:

Here are some frequently asked questions people have about angioplasty and bypass procedures.

Which is better, bypass surgery or angioplasty?

An angioplasty is quicker and less invasive than a bypass. However, coronary bypass may be the better option if you have multiple blockages or a blockage in the larger left coronary artery.

What is the survival rate of bypass compared to angioplasty?

In a 2023 review of studies, researchers found people who received angioplasty with stenting did not have worse survival rates than people who received a bypass in the 10 years after their procedure. In other words, there was no major difference in survival rates after 10 years.

Which surgery is best for heart blockage?

A coronary bypass is more extensive and allows blood to completely circumnavigate a blockage.

Why is angioplasty not recommended?

You may not be eligible for angioplasty if you have:

  • small blood vessels
  • bruising of blood vessels
  • an inability to tolerate antiplatelet therapy
  • allergy to stent components
  • severely calcified arteries
  • active malignancy with decreased life expectancy
  • recent hemorrhagic stroke
  • high bleeding risk or active bleeding

Your healthcare team can help you decide whether coronary bypass or angioplasty may benefit you more. Lifestyle strategies or medications may treat minor narrowing of your arteries.