Revaskularisation

Revaskularisation, or revascularisation, describes medical procedures aimed at restoring blood flow to tissues that have become ischemic due to blocked or narrowed arteries. In cardiology, it refers primarily to restoring perfusion to the heart muscle after coronary artery disease or myocardial infarction, but the term can also apply to other vascular beds such as limbs or organs.

Procedures are generally grouped into coronary revascularisation, which targets the heart, and peripheral revascularisation for other regions. Coronary revascularisation includes percutaneous coronary intervention (PCI), such as balloon angioplasty with or without stent implantation, and surgical revascularisation by coronary artery bypass grafting (CABG). In the acute setting of a heart attack, pharmacologic reperfusion with thrombolytic therapy or primary PCI may be used to re-establish coronary flow.

Indications for revascularisation include relief of disabling angina, reduction of myocardial infarction risk, and improvement of survival in selected patients, particularly those with multivessel disease or disease of the left main coronary artery. Peripheral revascularisation may be performed for limb ischemia or compromised organ perfusion. Decision-making considers symptoms, anatomy, comorbidities, and patient preferences.

Before intervention, diagnostic imaging such as coronary angiography identifies blockages and guides treatment. Risks include bleeding, infection, kidney injury from contrast, arrhythmias, stroke, and myocardial injury. Outcomes depend on disease burden and timely treatment; PCI offers quicker recovery and less invasive management, while CABG can provide durable relief for complex multivessel disease.

Post-procedure care emphasizes antiplatelet therapy, lipid management, blood pressure and glucose control, smoking cessation, and cardiac rehabilitation to reduce recurrence and improve long-term prognosis.