Radiology, Vol 155, 323-326, Copyright © 1985 by Radiological Society of North America
Percutaneous transluminal coronary angioplasty with an over-the-wire system
DC Levin, P Ganz, P Friedman, R Abben, JD Garnic and LM Boxt
The original Gruentzig coaxial catheter system for percutaneous
transluminal coronary angioplasty (PTCA) utilized a blunt, closed-end,
inner balloon catheter with a short guide wire attached to its tip. Options
for safely crossing severe stenoses with this large, nonmaneuverable
catheter were limited. More recently, over-the-wire systems have been
developed in which the lesion initially is crossed with a small-caliber
floppy or steerable guide wire, then by the balloon catheter advanced over
the wire. Technical success was achieved in 78 of our first 100 PTCAs with
this system. Significant cardiac complications occurred in ten patients,
seven of whom required emergency coronary bypass surgery. A recently
published survey of all PTCA techniques reported a technical success rate
of 62%. Our higher success rate may be attributed to certain advantages of
the over-the- wire system, which are discussed in detail. A learning curve
is associated with this procedure: our success rate was 65% in the first 20
cases but 81% thereafter. These results can be considered typical of those
expected at hospitals now beginning PTCA programs with advanced
over-the-wire technology.
