Percutaneous transluminal coronary angioplasty.

IN 1964 Dotter and Judkins described a new technique in which a special dilating catheter was used for transluminal compression of localized arteriosclerotic obstructions.' The procedure has since been applied by other investigators, particularly abroad, for the management of arteriosclerotic peripheral vascular disease and to obstructions in the renal arteries.2 In 1977, after a series of experiments in cadaver hearts and in canine hearts after surgical creation of coronary arterial constrictions, Dr. Andreas Gruntzig performed the first nonoperative transluminal angioplasty of coronary arteries in man.4 To accomplish this, he devised a special balloon catheter that could be placed fluoroscopically through a guiding catheter across relatively tight proximal coronary arterial obstructions. The balloon is inflated with'a half-saline, half-Renografin solution, subjecting a proximal obstructive lesion to 4-6 atmospheres of pressure. The pressure is applied for a few seconds and can be repeated several times until demonstrable improvement occurs as judged by lessening of the arterial pressure drop across the obstructive segment and by immediate arteriographic evidence of improved luminal diameter. Since this pioneering effort the procedure has been performed in more than 200 patients throughout the world.5 Most of the procedures have been done either by Dr. Griintzig or by physicians in three other centers that have collaborated closely with him and have followed a common protocol and technique (Dr. Richard K. Myler, St. Mary's Hospital, San Francisco; Dr. Simon H. Stertzer, Lennox Hill Hospital, New York; Dr. Martin Kaltenbach, University Hospital of Frankfurt, West Germany). Recently Dr. Griintzig reported his experience with this technique.6 It has created interest not only in the profession, but