Balloon angioplasty in the treatment of coronary artery disease : clinical and angiographic assessment
(1992)
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- Cardiac catheterisation began with the self-demonstration by Forssmann in 1929 of the feasibility of introducing a catheter into the human heart without complication. In the early 1930’s, Castellanos and others performed the first visualization of cardiac anatomy using opaque media and X-rays. Later on, in the 1940’s, Cournand and others pioneers, including Lenegre and Lequime, performed right heart catheterization providing valuable information about cardiovascular physiology and from 1945 catheterization was used for diagnostic purpose in living patients. <BR> With the development of selective angiography, imaging information was added and the heart became one of the most accessible organs for physiologists and clinicians. During the first decades, catheterization growth was essentially related to the continuing progress in surgical technique for treating congenital cardiac disease, acquired valvular disease, which remains the prime killer in western countries, has led to an explosive growth of selective coronary arteriography since the first case performed by Sones in 1958. <BR> A new field of activity – and probably a new area) emerged in 1977 when Gruentzig introduced percutaneous transluminal coronary angioplasty, becoming the pioneer of interventional cardiology. Since this successful experience, catheterization laboratory practice has moved from an exclusively diagnostic to an interventional therapeutic approach for different cardiovascular disorders, but essentially for coronary artery disease. This was also the case in our laboratory since the year 1981. <BR> Our initial experience demonstrated that angina could be substantially relieved by successful balloon angioplasty in symptomatic patients with single or double vessel disease, allowing to rapidly extend the technique to more complex clinical and anatomical cases. Application of angioplasty in patients with unstable angina or impending myocardial infarction confirmed the efficacy of the technique in selected cases with complex, fissured plaques, even in the presence of partial or extensive thrombus formation, as observed in total coronary occlusion. Finally, experience demonstrated that angioplasty, usually in combination with the use of thrombolytic drugs, could be performed with success in evolving or recent acute myocardial infarction. In this broad spectrum of clinical indication, the goal of angioplasty as revascularization procedure may vary. In elective procedures for stable angina, the goal of suppressing coronary obstruction is to relieve symptomatic exercise induced myocardial ischemia in order to improve the quality of life of these patients. Part A of this work reviews general data on immediate and long term results in a large group of consecutive patients, focusing on the clinical follow-up and the restenosis probability and detection. In acute coronary syndromes, angioplasty procedure aims not only at the coronary vessel patency but essentially at the reperfusion of the jeopardized myocardial area in order to prevent or limit the usually present left ventricular dysfunction, which is the strongest predictive parameter for mortality on patients with coronary artery disease. Part B deals with the effects of successful angioplasty on left ventricular function in patients with impending or evolving myocardial infarction. <BR> In summary, this work was aimed to critically analysis some specific aspects of coronary angioplasty used as a therapeutic tool in clinical practice. The intent was not to compile extensive theoretical, technical or experimental data but to concentrate on the observations and results proceeding from our clinical experience in this field. This work is far from being a textbook or an encyclopaedia, but perhaps the lessons emerging will improve our daily practice and benefit the patient. In absence of such final results, it would not have achieved its purpose
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Renkin, J. (1992). Balloon angioplasty in the treatment of coronary artery disease : clinical and angiographic assessment. https://hdl.handle.net/2078.5/111256