[Interventional cardiology. Indication of angioplasty]

Coronary angioplasty is currently a technique reaching its maturity. The technical perfection of balloons is such that increasingly complex coronary lesions are accessible, with a very high success rate. Approximately 30,000 angioplasties are performed in France each year, France thus being the second country in Europe for the technique. While balloon angioplasty remains the standard technique, many others have developed. Among them, the rotatory auger or rotablator enables the removal of atheroma from the coronary vessel, thereby facilitating, in the case of calcified and complex lesions, the subsequent balloon procedure. Coronary stents have obviously modified the management of complications during angioplasty and lower the incidence of poor results of balloon coronary angioplasty. Extension of the indications of stenting appears to be fairly clear in the context of aortocoronary bypass, but is more open to doubt in the case of primary lesions. However, recent studies appear to suggest better long-term results following stenting. The weak point of these techniques remains restenosis and techniques of the future will be those which provide a perfect immediate result and avoid restenosis later. In this context, massive strides in molecular biology and gene therapy seem to be of major interest.