Management of high-risk coronary angioplasty.

Many advances have been made in the decade since Dr. Andreas Gruentzig performed the first percutaneous transluminal coronary angioplasty. The technique, which started out as a nonsurgical revascularization procedure for 1-vessel disease, has spread to use in multivessel disease and acute myocardial infarction. Over the last several years, a number of refinements have made angioplasty safer. These techniques/devices have been applied to high-risk patients to allow angioplasty to be performed safely. High-risk patients include those with large amounts of myocardium at jeopardy from a single target lesion and those patients with reduced left ventricular function. The techniques/devices that enhance safety include: (1) the use of a perfusion balloon catheter, (2) infusion of oxygen-carrying substances to the distal coronary artery, (3) coronary sinus retroperfusion, (4) intraaortic balloon pump support, and (5) supported angioplasty.