Current Problems in PTCA

Since coronary angioplasty was first practiced by Andreas Gruntzig in 1977, it has rapidly developed into a technique widely used on patients with chronic and acute coronary heart disease. The meeting described in this book was held under the auspices of the working group of our national society, chaired by Prof. Kaltenbach, Frankfurt, and by Prof. Meyer, Mainz, in cooperation with Stanford University. It is an attempt to present various cardiologists' appraisals of the current position ofPTCA in clinical medicine. PTCA is far from easy, as its mechanism is critically balanced between success and fail­ ure. Therefore the experience of more than one hundred cases is generally regarded as ne­ cessary for cutting down complications and achieving a high rate of sli'ccess. Furthermore, success and complications are a result not only of technical expertise, but also of patient selection. The emphasis of the workshop was on discussion of some unsolved problems and open questions such as: - What are the reliable indication guide-lines? - What are the established guide-lines for deciding, once a complication occurs, between operative and non-operative treatment? - What are the indications and limitations for the combined use of thrombolysis with PTCA in acute myocardial infarction? - When and at what intervals should PTCA be applied after successful lysis? - Who are the candidates for dilatation of main stem stenosis? - When should one attempt to open occluded arteries and which technique shows the most promise? Front Matter....Pages I-VIII Diagnostic Procedures Before, During, and After PTCA....Pages 1-7 Current Indications for PTCA....Pages 9-19 Early and Late Results After Percutaneous Transluminal Coronary Angioplasty Compared with Bypass Operation....Pages 21-26 Detection of Ischemia during PTCA with Extended Electrocardiographic Monitoring....Pages 27-34 Effect of Coronary Occlusion During Percutaneous Transluminal Angioplasty on Systolic and Diastolic Left Ventricular Function, Coronary Hemodynamics, and Myocardial Energetic Metabolism....Pages 35-53 Selective Coronary Perfusion via Angioplasty Catheters — Technical and Physiological Aspects....Pages 55-61 Prevention of Thrombosis in Percutaneous Coronary Angioplasty....Pages 63-66 Platelets, Prostanoids and Percutaneous Transluminal Coronary Angioplasty....Pages 67-74 Coronary Spasm in Patients Treated by Percutaneous Transluminal Coronary Angioplasty....Pages 75-81 Incidence of Restenosed Coronary Lesions after PTCA Analysis of Possibly Meaningful Factors....Pages 83-88 Influence of Balloon Size on Recurrence Rate of Coronary Artery Stenosis. Results of a Prospective Investigation....Pages 89-93 Significance of the Angiographic Coronary Morphology for the Early Outcome of PTCA....Pages 95-100 Obstructions Within or Immediately Adjacent to the Left Main Coronary Artery: an Indication for PTCA?....Pages 101-107 Recanalization of Totally Occluded Coronary Vessels by Percutaneous Transluminal Coronary Angioplasty....Pages 109-115 Percutaneous Transluminal Coronary Angioplasty in Acute Myocardial Infarction With and Without Prior Systemic Fibrinolytic Therapy....Pages 117-121 The Follow-up of PTCA Using Thallium-201 Myocardial Scintigraphy....Pages 123-130 Is the candidate for PTCA always also a candiate for aortocoronary bypass operation?....Pages 131-133 Complementary Relationships of Coronary Bypass Surgery and Percutaneous Transluminal Coronary Angioplasty....Pages 135-141 Surgical Procedures During Evolving Infarction and After Thrombolysis and Unsuccessful PTCA....Pages 143-148