Use of the perfusion balloon as a primary dilation device

The development of more user-friendly and versatile perfusion balloon catheters has increased the use of prolonged dilations as a primary catheter treatment for coronary artery disease. In a multicenter randomized trial, the use of these devices to prolong initial inflation durations resulted in improved angiographic outcomes when compared with conventional short dilations. This benefit was most apparent in stenoses with complex morphology. Use of the perfusion balloon as a primary device is also appealing because of its ability to reduce anginal pain and hemodynamic changes during balloon inflation. Clinical experience suggests that primary use of the perfusion balloon may improve patient stability during procedures in which the treated segment jeopardizes a large percentage of the functional myocardium. An observational series has demonstrated the excellent outcomes which can be achieved in selected patients using a strategy of primary perfusion angioplasty with stent bailout when needed. Selection of a perfusion balloon rather than a conventional balloon as a primary device has the potential to decrease overall balloon usage approximately 25%, but the economic benefit of this strategy will depend on the cost of the perfusion balloon relative to a conventional balloon. Retrospective analyses suggest that perfusion angioplasty as a primary treatment strategy compares favorably with directional atherectomy for left anterior descending lesions. The use of coronary stents has not been directly compared to perfusion angioplasty as a primary treatment for coronary lesions, but use of a perfusion balloon as an initial device may have broader applicability, lower cost and less technical demands on the operator compared to stent deployment. In conclusion, when overall applicability, clinical outcome and cost are considered, the primary strategy of prolonged dilation with a perfusion balloon should have an important role in coronary intervention.