Percutaneous revascularization modalities in heart transplant recipients

Accelerated allograft vasculopathy significantly limits the survival of hea rt transplant recipients. The prevalence of allograft coronary artery disea se is as high as 18% by 1 year and 50% by 5 years following heart transplan t. Heart failure and sudden cardiac death are the two most common clinical presentations. In heart transplant recipients with severe, discrete focal a llograft vascular disease, percutaneous balloon angioplasty is a viable pal liative option, However, its application is limited by a significant resten osis rate and progression of allograft disease in nontreated segments. Diff use disease with tapering of vessels may be approached by debulking devices . Emerging revascularization modalities for focal stenoses and some of the diffuse tapering vessels include coronary stents, rotational atherectomy, V arious wavelength lasers, and, to a lesser extent, directional atherectomy, Conceivably, stents will reduce restenosis rates related to focal, discret e plaques; yet it is unknown whether they will be efficacious in short- and long-term treatment of diffusely diseased segments affected by allograft d isease, Accurate assessment of clinical outcomes and long-term evaluation i s imperative prior to acceptance of these devices as fundamental interventi onal tools for treatment of allograft coronary artery disease, (C) 1999 Wil ey-Liss, Inc.