Current Problems in PTCA

Since coronary angioplasty was first practiced by Andreas Gruntzig in 1977, it has rapidly developed into a technique widely used on patients with chronic and acute coronary heart disease. The meeting described in this book was held under the auspices of the working group of our national society, chaired by Prof. Kaltenbach, Frankfurt, and by Prof. Meyer, Mainz, in cooperation with Stanford University. It is an attempt to present various cardiologists' appraisals of the current position ofPTCA in clinical medicine. PTCA is far from easy, as its mechanism is critically balanced between success and fail­ ure. Therefore the experience of more than one hundred cases is generally regarded as ne­ cessary for cutting down complications and achieving a high rate of sli'ccess. Furthermore, success and complications are a result not only of technical expertise, but also of patient selection. The emphasis of the workshop was on discussion of some unsolved problems and open questions such as: - What are the reliable indication guide-lines? - What are the established guide-lines for deciding, once a complication occurs, between operative and non-operative treatment? - What are the indications and limitations for the combined use of thrombolysis with PTCA in acute myocardial infarction? - When and at what intervals should PTCA be applied after successful lysis? - Who are the candidates for dilatation of main stem stenosis? - When should one attempt to open occluded arteries and which technique shows the most promise?