Changed learning curve for percutaneous transluminal coronary angioplasty. Implication for the future treatment of coronary artery disease.
As with all skilled techniques, there is a learning curve for percutaneous coronary angioplasty. This curve has been well described in the literature and it is generally quoted that an initial success rate of 70 to 75 percent in reaching and crossing lesions is to be expected during the first 20 cases. However, the introduction of the steerable or guidewire-directed dilation catheter has altered the learning curve. After an initial experience of six nonsteerable percutaneous transluminal coronary angioplasty procedures, 20 consecutive steerable percutaneous transluminal coronary angioplasty procedures were performed without a single failure to reach or cross a lesion. These 20 consecutive steerable coronary angioplasty procedures included eight single left anterior descending lesions, two double (lesions located in series) left anterior descending lesions, six single right coronary lesions, one double (lesions located in series) right coronary lesion, and three single circumflex lesions. It is concluded that the introduction of the steerable system for percutaneous transluminal coronary angioplasty has shifted the learning curve, and that skilled and experienced coronary angiographers beginning a coronary angioplasty program can expect an initial success rate in reaching and crossing obstructive coronary lesions far in excess of the figures quoted in the literature. This may have significant implication for the ultimate availability of percutaneous transluminal coronary angioplasty to patients with coronary artery disease.
Feit
A
A
Reddy
C V
CV
Khan
R
R
Meilman
H
H
El-Sherif
N
N
D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000295:instrumentation* / Q000379:methods; D006328:Cardiac Catheterization / Q000295:instrumentation; D003327:Coronary Disease / Q000473:pathology / Q000628:therapy*; D003331:Coronary Vessels / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged