[Prospects in the treatment of stenosis of the coronary arteries].
Treatment of stenosis of coronary arteries has progressed considerably since the introduction of angioplasty by Grüntzig. There are three problems associated with angioplasty: reocclusion, restenosis and extension of indications. To solve these problems, a good many techniques designed to flatten or destroy the plaque have been developed. Hemoperfusion balloons can be used to treat reocclusion by prolonged inflation and may reduce the rate of restenosis. Methods for assisting blood circulation (CPS or hemopump) extend the indications for angioplasty to inoperable patients. Stents hold the vessel open and hence prevent reocclusion. They can be useful for stenosis of shunts but in general are thrombogenic and have not proved efficacious in preventing restenosis. Laser-heated metal probes (hot tips) generate spasm and thrombosis. Lasers are now used to heat balloons which allow reattachment of grafts and reduction of restenosis. The excimer appears more promising. Atheroma is currently the subject of some interest and atherectomy has proved feasible, but the indications are as yet undefined. Although new techniques have introduced the possibility of treating certain reocclusions, none has proved effective in prevention of restenosis. The multiplicity of instruments currently available allows gradual extension of the indications for angioplasty.
Lablanche
J M
JM
Service de Cardiologie B et Hémodynamique, Hôpital Cardiologique, Lille.
D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000601:surgery / Q000628:therapy*; D006801:Humans; D053685:Laser Therapy; D015425:Myocardial Reperfusion; D012008:Recurrence
Perspectives dans le traitement des sténoses des artères coronaires.