Percutaneous Transluminal Angioplasty of the Supra-aortic Arteries

Abstract

Dilatation of arterial stenoses by means of percutaneous transluminal angioplasty (PTA), introduced by Dotter and Judkins [4] with coaxial Teflon catheters in 1964, has achieved increasing application in special clinics and medical centers for the treatment of arterial obstructions in the pelvis and lower extremities, particularly after the development of balloon catheter systems [12]. It did not take long before experimental studies were initiated to determine the efficacy of this simple therapeutic procedure free of the hazards of a general anesthesia in treating lesions of the coronary, carotid, and vertebral arteries. In 1976 and 1978 [46] the first reports appeared on experimental results in the dilatation of coronary artery stenoses [9, 10] and of carotid artery stenoses in dogs [17, 21]. As this book goes into print, the first results of clinical studies in the percutaneous treatment of coronary artery stenoses [10, 11] have become available. Cardiologists have embraced the technique, and it is now being tried in several clinics. On the other hand, the first experimental results in the internal carotid arteries are being greeted with criticism and scepticism by vascular surgeons. This criticism is summarized by a statement made by the vascular surgeon van Dongen [40]: “The performance of percutaneous transluminal angioplasty in the carotid can bring an otherwise generally recognized therapeutic principle in disrepute.” Such criticism is apparently unjustifiable, however, if one assumes that the frequency of embolization (1%–3%) caused by PTA is the same in arteries supplying the brain as it is in the femoral and popliteal arteries [46].