[Treatment of atherosclerosis. New percutaneous intraluminal techniques]

Balloon-catheter angioplasty was introduced by Gruntzig in 1977 and has since proved effective, but 3 problems are still encountered: immediate reobstruction, restenosis during the first 3 months and extension of the procedure to a greater number of cases. In an attempt to solve these problems, other percutaneous/technics, associated or not with balloon angioplasty, have been devised. They are: (1) intraluminal stents which perfectly keep the vessel open after balloon angioplasty; (2) vaporization of atheromatous plaques by laser, and notably excimer laser which results in immediate recanalization, later completed by balloon angioplasty; (3) heating balloons which stick dissections and improve the immediate success rate; (4) atheroma-cutting and storing systems, such as Simpson's atherocath, cutting and aspirating systems, such as Stack's transluminal extraction catheter, or erasing systems, such as Auth's rotablator; (5) other sources of energy, such as ultrasounds, microwaves and radiofrequencies, will perhaps, be used in the near future. None of these new technics has solved the restenosis problem, but all have proved effective in suppressing the obstacle, there by giving hopes of reducing immediate complications and gradually widening the indications of percutaneous revascularization.