The role of coronary angioplasty in the management of coronary artery disease
Rowlands, D.J.
Annales Chirurgiae et Gynaecologiae 82(2): 75-85
1993
ISSN/ISBN: 0355-9521 PMID: 8357237 Document Number: 414130
Coronary angioplasty is well established as a treatment modality for coronary artery disease. Clinical experience leaves no doubt that it can be very effective in relieving symptoms in patients with unstable angina and with chronic stable angina. There are, at present, no controlled trials to demonstrate its efficacy, though several are under way. In straightforward cases the initial success rate is about 90%, but for each lesion dilated, there is about a 30% chance of significant re-stenosis. Re-stenosis (which is the main chronic complication) usually occurs early--often within a few weeks of the procedure--and it rarely develops later than six months after the procedure. Acute closure of the dilated artery (usually within an hour or two of procedure) is the most feared acute complication and is the main factor contributing to the 0.2% acute mortality rate and to the 1-5% risk of emergency coronary artery bypass grafting. The procedural risk does not increase progressively with serial interventions (in contrast to coronary artery surgery). Furthermore, angioplasty is often undertaken following surgery when stenoses have developed within the grafts, at the graft-vessel anastomosis, in the native vessels distal to the graft insertion or in native ungrafted vessels. Angioplasty is less costly than coronary surgery, although the 30% re-stenosis rate implies a requirement for additional interventions as a result of which the cost differential is not as great it initially appears.