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Harrison's Principles of Internal Medicine, 18e
| Part 10. Disorders of the Cardiovascular System > Section 5. Vascular Disease > |
Chapter 246. Percutaneous Coronary Interventions and Other Interventional Procedures
Sections: Percutaneous Coronary Interventions and Other Interventional Procedures: Introduction, Technique, Success and Complications, Conclusions, Further Readings.
Topics Discussed: ischemic heart disease; percutaneous coronary intervention.
Excerpt:"Percutaneous transluminal coronary angioplasty (PTCA) was first introduced by Andreas Gruentzig in 1977 as an alternative to coronary bypass surgery. The concept of percutaneous dilatation of the atherosclerotic peripheral vessels was initially demonstrated by Charles Dotter in 1964 in peripheral vessels where rigid catheters of graduated diameter were used to progressively enlarge the vessel lumen. The development of a small inelastic balloon catheter by Gruentzig allowed expansion of the technique into smaller peripheral and coronary vessels. Initial coronary experience was limited to the small percentage of patients who had single-vessel coronary disease and discrete proximal lesions due to the technical limitations of the equipment. Advances in technology and greater operator experience allowed the procedure to grow rapidly with expanded use in patients with more complex lesions and multivessel disease; by 1990 it was being performed in more than 300,000 patients annually. The addition of atherectomy devices that removed plaques aided in the growth of the procedure, but the introduction of coronary stents in 1994 was one of the major advances in the field. These devices reduced acute complications and reduced by half the significant problem of restenosis (or recurrence of the stenosis)...."
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