Education And Debate

Fortnightly Review: New methods of making blocked coronary arteries patent again

BMJ 1994; 309 doi: (Published 03 September 1994) Cite this as: BMJ 1994;309:579
  1. L Corr
  1. Regional Cardiac Unit, Brook General Hospital, London SE18 4LW.

    The use of percutaneous transluminal coronary angioplasty is limited by procedural complications and the serious drawback of restenosis, but some new techniques have been developed in an attempt to lower the complication rate for difficult lesions and reduce the rate of restenosis. These include devices to physically remove atheromatous plaque, such as the Simpson Coronary AtheroCath and the transluminal extraction catheter, as well as devices to ablate the plaque in situ, including the Rotablator and the excimer laser catheter. Although each device may have advantages in certain types of lesion, few data on their use have been reported in properly controlled randomised trials. The data available so far do not suggest that these devices will be safer than balloon angioplasty or that they will reduce restenosis. However, using metallic stents to support coronary arteries after balloon angioplasty seems to reduce acute complications and to lower the rate of restenosis, and the use of stents is likely to increase.

    In the United Kingdom almost 10 000 patients with coronary artery disease were treated with percutaneous transluminal coronary angioplasty in 1991, and the use of the procedure is increasing at 17% a year.1 But balloon angioplasty has drawbacks, which divide into two main areas: the first is technical, related to the feasibility of carrying out the angioplasty and obtaining a satisfactory immediate result (fig 1); the second relates to the healing process, which may be exuberant enough to cause a restenosis.

    FIG 1

    Balloon angioplasty. With the guiding catheter in the ostium of the coronary artery, the fine guidewire is manipulated across the stenosis (1); the deflated balloon is advanced over the guidewire (2) and inflated once across the stenosis (3); the stenosis is reduced (4) by splitting and compressing the plaque

    Balloon angioplasty

    The technical problems are predictable (box). None the less, increasing experience …

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