Percutaneous transluminal coronary angioplasty

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It has been a half century since Forssman in Germany initiated t he era of invasive diagnostic cardiology. Following his courageous lead, further definition of the possibilities of cardiac catheterization occurred in the United States in the early 1940s. The cardiac catheter as a diagnostic tool achieved a dramatic new plateau two decades ago in Cleveland when Sones et al1 realized the potential for investigating coronary anatomy, normal and abnormal, and a new era in investigational cardiology began.

The cardiovascular catheter has also been an equally interesting therapeutic device. It has been used to open patent for a men ovale in transposition, close atrial septal defects and patent ductus arteriosus, interrupt inferior vena caval return in patients with recurrent pulmonary embolic disease, and treat heart block (in its many forms) with a variety of brilliant pacemaker catheter devices.

A particularly imaginative therapeutic catheter application was introduced by Dotter and Judkins2 in 1964 to improve peripheral blood flow in arteries with diffuse and discrete arteriosclerotic stenosis. This system utilized a coaxial catheter system and the procedure was termed transluminal angioplasty. Their pioneering efforts were developed further in Europe by many investigators, in particular, Zeitler3 in Nuremberg, Griintzig4,5 in Switzerland who modified the Dotter technique by employing a single catheter system with a distensible (balloon) tip, which achieved great success in treating peripheral arteriosclerotic lesions (initial patency, 83%; 3-year patency, 73%).

In 1976 Griintzig et al6-8 further modified the peripheral angioplasty system to perform coronary angioplasty initially in dogs and subsequently in human . . .



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