Balloon Angioplasty

It is difficult to think of balloon angioplasty as a mature technique with which new devices must now be compared. It seems as if it were only yesterday that Gruentzig demonstrated a new and radical approach to myocardial revascularization.1 As success rates have leveled off at 90% or higher, half or more of current patients have complex or multivessel disease, bail-out methods and surgical backup systems have been tested and refined, and clinical trials are now well under way to compare percutaneous transluminal coronary angioplasty (PTCA) with modern bypass surgery (the Emory Angioplasty Versus Surgery Trial [EAST] results will be available in summer 1993), the method has indeed entered a mature phase. Maturity, of course, in no way implies perfection. There are technical problems with angioplasty that fall into one of three categories: 1) lesions that cannot be opened (usually chronic total occlusions), 2) abrupt closure at the time of PTCA that causes complications, and 3) restenosis of the lesion in the months following the procedure that leads to recurrent ischemia. Because problems exist, other methods for opening arteries should be considered.