[Recent instrumental developments in percutaneous transluminal angioplasty (PTA)]

In addition to the balloon-catheter for PTA a number of new devices have been developed in recent years. Among them the most outstanding are laser beam application, mechanical devices for recanalization and endoprostheses for stenting of the vessels. The initial fascination by laser technique in PTA has given way to a matter-of-fact appreciation of the method. Up to now no available laser system achieves better clinical results than conventional PTA in the long run. Although there is much potential in the laser principle, it still is to be regarded as experimental. As for mechanical devices the fast rotating Kensey-catheter has not been proven superior to balloon PTA in our hands neither to remove organized or fresh thrombotic occlusive matter. A slowly rotating catheter (Rotacs) facilitates primary recanalisation of long occlusions prior to balloon dilatation. Atherectomy by the Simpson-catheter provides samples for histological studies but is indicated only in special situations. Numerous other mechanical percutaneous endarterectomy devices are under development, but clinical long term evaluation is not yet available. Vascular stents - self expandable or balloon expandable systems - may serve to keep the newly dilated arterial lumen open and to prevent late recurrences. While in larger vessels such as iliac arteries or aorta good long-term results after insufficient PTA were shown, other indications are still experimental. For all of these newer technologies both their relative effectiveness and the extent to which they may compare with or complement balloon PTA remain to be determined.