Percutaneous transluminal angioplasty.

Abstract

Percutaneous transluminal angioplasty is a relatively new procedure; its technology is still evolving and experience with it is increasing rapidly. There are only limited follow-up data on patients who have undergone this technique. Rates of late patency of the dilated arteries and potential long-term complications in patients treated with percutaneous transluminal angioplasty are unknown. Therefore, physicians performing this technique should collect and report long-term follow-up data on their patients, using clinical, hemodynamic, and angiographic determinations. Physicians evaluating the literature must recognize the substantial impact that physician experience, patient selection, and measures of clinical success have on reported results. Before sending a patient for angioplasty, one should consider the experience of the center where the procedure will be done. In making comparisons between treatments and techniques, one must be sure that comparable populations are studied and that angiographic, clinical, and hemodynamic variables are measured in all patients, because patients may show improvements in some variables but not others. The availability of improved balloon-tipped catheters, more potent vasodilators, and enhanced experience and skill may bring about improved results from percutaneous transluminal angioplasty in the future. Moreover, advances in diagnostic technology, such as the refinement of digital subtraction angiography, may alter the approach to patients with vascular disease, facilitating the identification of potential candidates at lower risk for this technique more efficiently. As new data emerge, particularly information dealing with the duration of therapeutic effect and the occurrence of late complications, continued reevaluation of the procedure will be necessary. Coronary percutaneous transluminal angioplasty is an alternative to coronary artery bypass graft surgery in patients with high grade stenosis (greater than 50% to 70%) confined to a single coronary artery and limiting anginal symptoms despite an adequate trial of medical treatment. The success of percutaneous transluminal angioplasty of a proximal left anterior descending artery lesion approaches that of coronary artery bypass graft surgery. Percutaneous transluminal angioplasty of other coronary artery lesions is somewhat less successful than that of coronary artery bypass graft surgery. Percutaneous transluminal angioplasty of multiple coronary arterial lesions remains investigational.