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A number of techniques are used to mechanically reduce or bypass atherosclerotic plaque. The definitive study of these techniques is the MASS-II trial. Even three-vessel coronary artery disease, as long as it is stable (no rest pain with ECG changes) has a low mortality and lives are not saved by bypass surgery, in spite of what Bill Clinton's surgeon claimed. Unstable angina or acute myocardial infarction (due to acute partial or complete blockage of a coronary artery with clot) are indications for thrombolysis (clot busters) or angioplasty. But these situations account for a small fraction of the total number of procedures performed.
These procedures only treat the angiogram and not the vast majority of plaque which is buried in the wall but which can rupture and cause heart attacks.
The MASS-II trial, the best randomized controlled trial to date, showed that angioplasty (PCI) is actually worse than medical therapy (drugs) and is contraindicated in stable coronary atherosclerosis. Disruption of plaque by the balloon inflation causes an immune response to the plaque contents, in particular modified LDL, also called oxidized LDL. Theoretically antibodies to the plaque contents could stimuate an inflammation in the other plaques and increase the chance of rupture of any plaque in the the coronary arteries. Bypass surgery helped anginal symptoms but did not prolong life or prevent heart attacks, as claimed by Bill Clinton's surgeon. Bill Clinton is a Rhodes Scholar and did not think to ask the surgeons for the evidence.
Likewise, the judges of the Supreme Court of Canada in the Chaoulli decision made a fundamental alteration in Canadian medical law after listening to a surgeon and said that "patients die as a result of waiting lists for public heath care". Why do sugeons have such an effect on otherwise intelligent people?
