Although balloon catheters are used as adjunctive devices in most modern-era interventional therapies, they stand alone in conventional PTCA. The technical design of conventional PTCA equipment has evolved considerably in the last several years. Improvements include more supportive and flexible guiding catheters, more trackable and flexible guide wires, and improved crossing profiles of balloon catheters. These technical improvements have led to a 92% procedural success rate, and less than a 1% rate of periprocedural mortality and emergency CABG (7).
Most luminal improvement following conventional PTCA results from plaque redistribution and overstretching of the vessel rather than plaque compression. Overstretching frequently results in elastic recoil following balloon deflation, often leaving behind a stretched vessel with some residual stenosis (8). Recent studies have shown that larger postprocedural lumen diameters are associated with less restenosis or larger lumens at 6-mo follow-up. This observation has come to be known as "bigger is better" (9). However, this benefit in late outcomes must be carefully weighed against the acute risk of coronary dissection and abrupt closure if oversized balloons are used (10). By reducing and even eliminating elastic recoil, new device strategies such as stenting and directional atherectomy can provide lower postprocedural residual stenoses (0-10%), which are associated with a lower rate of restenosis. Fortunately, achieving a larger lumen diameter with new device strategies does not carry the same risk of dissection and abrupt closure as conventional PTCA.
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