Transluminal coronary angioplasty : an investigational tool and a non operative treatment of acute myocardial ischemia

Since the introduction of coronary angioplasty in 1977, this procedure has gained increasing importance in the treatment of coronary artery obstruction. From the available evidence it can be estimated that this therapeutic tool will gain even more momentum from the tens of thousands of patients who will be treated in the next few years. Information about the indications, benefits and risks of the coronary angioplasty is accumulating rapidly, in addition to publications about refinements of the technique itself. Recently, a number of investigators have realised that coronary angioplasty, is not only a therapeutic tool, but can, during the procedure. be used as a source of diagnostic information. When the catheter is placed across a coronary artery obstruction, inflation of the balloon produces transient myocardial ischemia. Before, during and after this period of severe ischemia studies of the performance of the myocardium at risk can be carried out. The fact that therapeutic coronary angioplasty is carried out in a cardiac catheterization laboratory, which is by definition optimally equipped for the measurements of hemodynamic parameters, has probably also contributed to the execution of these investigations. The combination of hemodynamic and biochemical parameters with morphological information from the coronary angiogram can be utilized for the quantification of myocardial involvement and the success of coronary artery dilatation with angioplasty. Studies of interactions with pharmacological substances are also feasible and informative. Coronary angioplasty has a most promising future as an unique means to gather insight in the intricacies of myocardial oxygen supply and demand in patients with coronary artery disease.