Coronary revascularisation refers to any procedure that restores blood flow to heart muscle deprived of oxygen due to narrowing or blockage of the coronary arteries. The aim is to relieve ischaemia, reduce symptoms such as angina, and in certain situations reduce the risk of heart attack and sudden cardiac arrest. Two main techniques are available: percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery.
PCI is performed via a catheter inserted into an artery at the wrist. A thin guidewire is navigated to the coronary blockage under X-ray guidance, a balloon is inflated to compress the plaque (angioplasty), and in most cases a metal stent is deployed to keep the artery open. PCI is performed as an emergency (primary PCI) for STEMI (ST-elevation myocardial infarction) and as an elective or urgent procedure for other significant coronary disease.
CABG surgery uses blood vessels harvested from the patient’s own body (the internal mammary arteries, saphenous vein, or radial artery) to create new channels bypassing the blocked coronary artery sections. CABG is generally preferred over PCI for patients with multi-vessel disease, diabetes, or severely reduced left ventricular function, as it tends to produce more complete revascularisation and better long-term outcomes in these groups.
The choice between PCI and CABG is guided by the anatomy of the coronary disease, the patient’s overall health, and a multidisciplinary Heart Team discussion. For cardiac arrest survivors found to have significant coronary artery disease, the urgency and type of revascularisation are determined by the clinical picture and cardiac investigations.
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