Success with coronary angioplasty as seen at demonstrations of procedure

To assess the real-life results of coronary angioplasty, unidentified participants made notes on 104 cases demonstrated live at twelve international angioplasty courses in 1991. The initially planned procedure was successful in 73% with crossover to another device in 20% for an ultimate success rate of 93%. Interventions lasted an hour on average and two devices on average were used per artery tackled. Rates of success and of complication necessitating reintervention were, for balloon angioplasty (57 cases) 81% and 19%, for directional atherectomy (16 cases) 75% and 0%, for the Rotablator (12 cases) 42% and 42%, for stent implantation (10 cases) 100% and 0%, for excimer laser angioplasty (6 cases) 17% and 33%, and for Rotacs recanalisation (3 cases) 67% and 0%, respectively. The complications were occlusions (threatened, acute, or delayed) and they were usually treated by balloon angioplasty or a stent. No death or myocardial infarction was reported. The observer attending the demonstration tended to take a less favourable view of the outcome than the clinician doing the procedure and in general the results of coronary angioplasty seemed inferior to those reported in journals. Interventions done before an audience will be unusually stressful but this will be outweighed by the fact that difficult cases with a low probability of success are rarely tackled during live courses. This survey suggests that conventional balloon angioplasty, complemented by stent implantation in selected cases, is the treatment of choice.