PTCA or aortocoronary bypass surgery--perspectives.

The indications for percutaneous transluminal coronary angioplasty have changed coincident with increasing physician and patient experience, and improved catheter technology. Although aortocoronary bypass surgery is an established "definitive" therapy for patients with asymptomatic coronary artery disease, the early results and risks of PTCA approach those of bypass surgery. PTCA has emerged as a preferred therapy for several anatomic and clinical subsets of patients. Procedural advantages of PTCA include the avoidance of thoracotomy, general anesthesia and cardiopulmonary bypass, resulting in fewer morbid complications and significantly reduced hospital costs. Although restenosis remains a major limitation of PTCA, rates of restenosis are diminishing and preliminary reports of sustained long-term patency are favorable. Consequently, coronary angioplasty is now established as a reasonable alternative therapy for an estimated 40 to 50% of patients who would otherwise require aortocoronary bypass surgery.