Percutaneous transluminal coronary angioplasty: current procedure and future direction

Atherosclerotic coronary artery disease is a progressive process for which effective palliative methods have been developed. The evolution of surgical bypass grafting over the past two decades now permits its application to most symptomatic patients. In 1977 an alternative, transluminal angioplasty, was first performed in man and has become widely accepted. Advanced radiographic equipment is required for adequate visual control of the placement of catheters, guide wires, and balloons. Careful manipulation of catheters is crucial to success and safety. Procedural details and proper follow-up are described. While a discrete stenotic lesion in a proximal single vessel is the ideal indication, some patients with double-vessel disease are now being accepted. In a personal experience of 2000 cases, successful dilatation was achieved in 88%. Emergency bypass surgery was required in 3.3%. Myocardial infarction occurred in 1.2%, and there were two deaths. In a larger, multiinstitutional study, the primary success rate has averaged 61%. Recurrent stenosis occurs in about 30%; redilatation is possible. Some perspectives about this effective, nonsurgical alternative are offered, including its potential for massive savings in the cost of handling obstructive coronary artery disease.