IMPROVING THE RESULTS OF CORONARY ANGIOPLASTY

Coronary angioplasty has changed dramatically in the past three years with major reductions in suboptimal results and restenosis rates, and improvements in safety, efficacy and cost-effectiveness. Intracoronary stem implantation with optimisation of strut expansion and the abando nment of anticoagulants after deployment, have led to less entry-size complication, facilitated early hospital discharge, virtually abolishe d subacute stent thrombosis and resulted in a 50% reduction in target vessel revascularisation. Adjuvant medical treatment with anti-platele t agents, including glycoprotein IIb/IIIa receptor inhibitors, improve s the safety of angioplasty and may further reduce the restenosis rate . Selective use of debulking devices has extended the indications for angioplasty. High resolution fluoroscopy, quantitative coronary angiog raphy and intracoronary ultrasound leading to improved diagnosis, equi pment selection and treatment have contributed to better outcomes. Fur ther clinical trials will compare angioplasty and stent implantation w ith coronary bypass surgery in patients with multivessel coronary dise ase, and may extend the indications for percutaneous transluminal coro nary angioplasty (PTCA) to selected patients with three vessel disease .