Percutaneous transluminal angioplasty.

IN 1963 Dr Charles Dotter, a radiologist of Portland, Oregon whilst performing an aortogram by retrograde catheterisation of the right iliac artery inadvertently passed his guide wire, and then a catheter, through a complete occlusion of the artery. There was a palpable though diminished femoral pulse in the groin and the catheter was passed easily. It was only when radiographs were taken that these revealed the catheter had been passed through an apparent occlusion of the iliac artery. It occurred to him that it might be possible to dilate a blocked or narrowed artery by this means. A year passed before the opportunity arose, when he successfully dilated a tight stenosis of the femoral artery in an elderly woman with gangrenous toes. This was achieved by passing a guide wire through the stenosis, then passing a catheter over it, then passing a larger catheter over that, thus dilating the artery step by step. Publication of this achievement' caused slight interest in Europe and less in America. At certain centres attempts were made to modify the technique by using a balloon catheter which could be positioned in the stenotic area and then inflated, but the various types of balloon catheter developed did not have the strength to dilate the stenosis, tending to take up an hour-glass shape.