Current trends in coronary angioplasty

: Coronary angioplasty still is an area of intensive development. The publication of the BARI data confirms and consolidates previous findings that balloon angioplasty and bypass surgery are equivalent in terms of mortality and major complications over a mid-term follow-up period. However, balloon angioplasty has a high rate of reinterventions, and is not recommended in diabetic patients with multivessel disease. The question, whether direct PTCA is a better treatment strategy of acute myocardial infarction than thrombolytic therapy remains unsettled despite a slight advantage for direct PTCA in several small randomized trials. The role of coronary stents has continuously expanded over the last years, as a tool against acute as well as long-term complications of angioplasty. This success is partly due to the finding that antiplatelet agents such as ticlopidine offer an effective protection against subacute stent thrombosis. The introduction of the GP IIb/IIIa platelet receptor blockers has provided another powerful tool against acute thrombotic complications, leading to a more aggressive interventional strategy in acute coronary syndromes. The development of alternative "devices" has further slowed down because of repeated publication of negative clinical results. Although different forms of laser energy applications, of local drug delivery, and of local irradiation are interesting research areas, their current impact on clinical practice is small.