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Education in Heart
CORONARY DISEASE
Intervention in coronary artery disease
  1. Stephan Windecker,
  2. Bernhard Meier
  1. Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
  1. Bernhard Meier MD, Professor and Head of Cardiology, Swiss Cardiovascular Center, Bern, University Hospital, 3010 Bern, Switzerlandemail:bernhard.meier{at}insel.ch

https://doi.org/10.1136/heart.83.4.481

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    Percutaneous transluminal coronary angioplasty (PTCA) was introduced into clinical practice more than 20 years ago.1 The breathtaking growth of percutaneous coronary interventions (PCI) during the 1990s in Europe (fig 1) reflects their widespread acceptance for coronary revascularisation, challenging coronary artery bypass grafting (CABG). This review provides an overview of current coronary interventional techniques with emphasis on adjunctive pharmacologic treatments and indications of PCI in patients with chronic coronary artery disease.

    Figure 1

    Development of cardiac interventions during the 1990s in Europe. Data are obtained from the coronary circulation working group of the European Society of Cardiology and represent more than 30 European countries with a population > 500 million people. Note the steady increase in the number of PTCAs, coronary stent, and CABG procedures, in contrast to new devices.

    Percutaneous coronary interventions

    Balloon angioplasty

    The balloon catheter is central not only to balloon angioplasty, but serves also as a complementary instrument for other intracoronary interventions such as delivery of stents or radiation sources. There are three types of ballon catheter (based on the relation between the guidewire and balloon)— fixed wire, over the wire, and Monorail balloon catheters—the latter being the most popular in Europe. There are five possible mechanism by which balloon angioplasty improves coronary haemodynamicsw1: (1) plaque compression; (2) plaque fracture; (3) stretching of the plaque free wall segment in eccentric lesions; (4) stretching of the vessel wall without plaque compression; and (5) medial dissection (fig 2). The most important mechanisms for improved blood flow appears to be the rupture and dehiscence of the atherosclerotic plaque, resulting in numerous fissures and sprouting of blood filled channels. The individual procedural outcome is a combination of different degrees of the above mechanisms, and the final luminal geometry following balloon angioplasty is determined by the ensuing remodelling of the vessel wall.w2–4

    Figure 2

    Schematic diagram of the …

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