Nonoperative Dilatation of Coronary-Artery Stenosis

Abstract

In percutaneous transluminal coronary angioplasty, a catheter system is introduced through a systemic artery under local anesthesia to dilate a stenotic artery by controlled inflation of a distensible balloon. Over the past 18 months, we have used this technic in 50 patients. The technic was successful in 32 patients, reducing the stenosis from a mean of 84 to 34 per cent (P less than 0.001) and the coronary-pressure gradient from a mean of 58 to 19 mm Hg (P less than 0.001). Twenty-nine patients showed improvement in cardiac function during follow-up examination. Because of acute deterioration in clinical status, emergency bypass was later necessary in five patients; three showed electrocardiographic evidence of infarcts. Patients with single-vessel disease appear to be most suitable for the procedure, and a short history of pain indicates the presence of a soft (distensible) atheroma likely to respond to dilatation. We estimate that only about 10 to 15 per cent of candidates for bypass surgery have lesions suitable for this procedure. A prospective randomized trial will be necessary to evaluate its usefulness in comparison with surgical and medical management.

Coronary dissection and total coronary occlusion associated with percutaneous transluminal coronary angioplasty: significance of initial angiographic morphology of coronary stenoses.

“…6 The predictive value of these angiographic findings for the occurrence of coronary vascular complications is low (< 10%). However, complicated lesions may represent a higher risk of coronary dissection or total coronary occlusion (local coronary risk).…”

Innominate Artery Stenting: A Single Centre Experience

“…In an effort to improve the mortality rate seen with transthoracic repair, in 1967 Diethrich et al [5] reported the first extra-anatomic SAT reconstruction; that improvement was subsequently confirmed by Crawford et al [4] who demonstrated a reduction in the mortality rate from 22% to 5.6% with extra-anatomic cervical repair. Following reports of the successful treatment of peripheral, renal and coronary artery atherosclerotic lesions by PTA [20,21], in the 1980s PTA techniques were applied to the lesions of SATs [9,10]. While these interventions were well tolerated by most patients and demonstrated acceptable perioperative efficacy and safety, long term patency and freedom from reintervention were found to be inferior to the surgical treatment.…”

Biodegradable stent

“…In 1977, Gruentzig of Switzerland successfully executed percutaneous transluminal coronary balloon angioplasty in stricture lesion to open up a new era of coronary artery [1]. This method dilates the balloon to widen the stricture lesion, which brings about the improvement of blood flow with the dilatational balloon to expand the narrowed coronary artery.…”