Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are revascularization techniques that are used to treat patients with both stable angina and acute coronary syndromes. As described below, both procedures are used in higher risk patients, with the choice of technique determined by several factors including severity of disease and the wishes of the individual. It is estimated that in 2003 CABG and PCI were carried out on approximately 270 000 and 650 000 patients in the USA, respectively.

CABG is a surgical procedure (Figure 43, right) which was introduced in the 1960s. Initially, CABG mainly involved the use of lengths of healthy superfluous blood vessels (conduits) which were removed and then attached (anastamosed) between the aorta and the coronary arteries distal to the stenosis, thus allowing a supply of blood to the heart that bypassed the obstruction. Conduits commonly used for CABG included saphenous vein segments harvested from the leg. However, these have limited long-term patency due to early postoperative thrombosis, intimal hyperplasia with smooth muscle proliferation within the first year, and the development of atherosclerosis after approximately 5–7 years. For this reason, the left internal thoracic (also termed mammary) artery (LITA) is now used for grafting much more widely than the saphenous vein. In general, the LITA is not disconnected from its parent (subclavian) artery, but is cut distally and attached to the coronary artery. Unlike the saphenous vein, 90–95% of LITA grafts remain patent after 10 years, and patients with a LITA graft to the crucial left anterior descending coronary artery have improved long-term survival compared with patients receiving saphenous vein grafts. If multivessel disease is present, the use of LITA and saphenous vein grafts can be combined. More recently, the use of both left and right internal thoracic arteries (bilateral internal thoracic artery) for grafting has become more common, especially for younger patients. For example, the right internal thoracic artery may be grafted to the left anterior descending coronary artery while the LITA is anastomosed to the circumflex system. The gastroepiploic and radial arteries can also be used for grafting.

CABG is usually perform with the patient on cardiopulmonary bypass

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