Today's approach to PTCA: how it is performed, who might benefit. When can angioplasty replace medical therapy or bypass surgery?

The use of percutaneous transluminal coronary angioplasty has expanded tremendously over the past decade. Because equipment has improved and physicians' experience has increased, the procedure is often appropriate for patients with complex lesions or difficult coronary anatomies. Currently, stenoses are successfully opened in more than 90% of patients. Angioplasty is an alternative to medical therapy for patients with one- or two-vessel disease; in some patients with multivessel disease, it is an alternative to coronary artery bypass graft surgery. Among elderly patients, those who are poor candidates for bypass surgery, those who have had previous bypass surgery, and those with acute myocardial infarction or cardiogenic shock, coronary angioplasty may be particularly useful.