Nonoperative Dilatation of Coronary-Artery Stenosis

TLDR

Percutaneous transluminal coronary angioplasty uses a catheter and balloon to dilate stenotic coronary arteries under local anesthesia. The study aims to evaluate the effectiveness of this technique versus surgical and medical management in a prospective randomized trial. The authors performed the procedure on 50 patients over an 18‑month period. In 50 patients, the procedure succeeded in 32, reducing stenosis from 84 % to 34 % and pressure gradient from 58 to 19 mm Hg, improved cardiac function in 29, but 5 required emergency bypass (3 with infarcts); single‑vessel disease and brief pain history predict suitability, and only 10–15 % of bypass candidates have lesions amenable to this technique. Published in N Engl J Med 301:61–68, 1979.

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<0.001) and the coronary-pressure gradient from a mean of 58 to 19 mm Hg (P<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 electrocardiograpic 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. (N Engl J Med 301:61–68, 1979)