Evolving applications of coronary angioplasty: technical and angiographic considerations

Coronary angioplasty (PTCA) is now applicable to selected patients with multiple vessel disease, total occlusions, tandem lesions and complex branch disease. Operator experience and skill contribute to a high success rate in complex anatomy, but equally important is appropriate case selection based on angiographic review of lesion morphology, branches, extent of coronary artery disease, and left ventricular function. Likewise, during and after the procedure similar angiographic assessment is important to determine resultant lesion morphology, branch anatomy, distal runoff, and adequacy of lesion dilatation. Thus, the outcome of angioplasty is dependent on the operator's ability to opacify the coronary arteries with minimal or no vessel/lesion overlap or foreshortening. Although coronary angiography has become more routine for many angiographers with the advent of angioplasty, the importance of high-quality angiography continues to be a major component for successful angioplasty.