Percutaneous revascularization strategies. Usefulness in ischemic coronary artery disease.

Current data support the use of revascularization procedures in many patients with ischemic symptoms or silent myocardial ischemia. Patients with extensive disease may benefit even when ischemia cannot be demonstrated. The development of new devices, particularly coronary stents, has broadened the population of patients who can be treated in the cardiac laboratory. Patients with acute myocardial infarction are best treated with direct angioplasty. If thrombolytic therapy is used, rescue angioplasty should probably be done when lysis is unsuccessful. Angioplasty should be used selectively in patients with successful thrombolysis. Both bypass surgery and angioplasty are reasonable initial strategies for patients with stable angina or significant silent ischemia who require coronary revascularization.