PTCA update: is your patient now a candidate? Even complex multivessel lesions may succumb to balloon dilation.

Indications for PTCA continue to grow. In complex multivessel lesions, PTCA now has high primary success and low complication rates. Dilation of chronic total occlusions is less successful than in subtotal occlusions but may relieve angina in some patients. Occluded saphenous vein grafts can be dilated and long-term patency achieved--particularly in grafts implanted for less than 36 months. Restenosis remains a major drawback; antithrombotic therapy (with heparin during PTCA and aspirin thereafter) is recommended. PTCA is a useful adjunct in acute myocardial infarction when thrombolytic therapy fails or is contraindicated, or when significant luminal narrowing remains after thrombolysis. Investigational devices--atherectomy catheters, lasers or laser balloons, and intracoronary stents--may further expand the role of PTCA.