The impact of interventional techniques on the practice of cardiology.

Coronary angioplasty has dramatically influenced the current practice of cardiology. Introduced only 10 years ago, it is now widely used as a means of revascularizing symptomatic patients with coronary artery disease. It is currently considered the optimal therapy for nearly one half of patients needing a revascularization procedure. Recent studies suggest that the technique can be satisfactorily and effectively used in elderly patients, those with multivessel disease, as well as patients with recent myocardial infarctions. Despite these broadening indications, success rates have risen to more than 90% in most centers while mortality has remained low (1%). Angioplasty is still limited by restenosis or renarrowing of the dilated vessel that occurs in 25-35% of patients within the first six months. Repeat angioplasty is successful in almost all patients and can even be repeated on multiple occasions if necessary. Long-term follow-up shows a low incidence of subsequent death or non-fatal myocardial infarction with a majority of patients asymptomatic after five years. New techniques are now being developed to permit recannulization of chronically totally occluded blood vessels as well as reduce abrupt vessel closure and early restenosis. These techniques include laser angioplasty, atherectomy and intravascular stents. The growth and expansion of angioplasty has given the cardiovascular physician an important new treatment modality for symptomatic patients with coronary artery disease. Its impact on the practice of medicine will be felt for many years to come.