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Percutaneous Transluminal Coronary Angioplasty: Part 2 Because of the increased level of local thrombogenicity, unstable ischemia is not an optimal environment for mechanical intervention. Nevertheless, in certain clinical situations (as [...]

Blockage of the heart's own blood supply from the coronary arteries causes heart attacks. In recent years a technique known as percutaneous transluminal coronary angioplasty has been developed; the procedure involves the insertion of a catheter, a small flexible tube, into the vessels by threading it through the vascular system from a needle placed into a peripheral vessel. Once the catheter is in place within the coronary arteries, an X-ray-opaque dye can be injected, which allows the physician to assess the degree of opening of the vessel. When blockages are found, a small balloon in the tip of the catheter can be inflated to open the blockage. The high recurrence of re-blockage (restenosis) that is known to occur in coronary vessels after PTCA was investigated. Patients were studied following PTCA by a repeated angiographic examination. Approximately 53 percent (257) of all patients with good surgical repair of complete stenosis (blockage) were found to have again developed stenosis. The PTCA method itself may be responsible for this poor overall result, as the method opens the vessels, but leaves irregular fragments of the atherosclerotic lesion remaining within the vessel that may be responsible for the restenosis. Recently laser beams have been mounted on catheters which permit them to be directed to the area of an atherosclerotic blockage and to vaporize the material. Perhaps such techniques may result in a better return of the lining of the coronary arteries (the intima) to their normal smooth configuration and produce a more long-lasting treatment for coronary artery stenosis.