Complex angioplasty: a surgeon's perspective.
Surgeons commonly have reacted with skepticism to the introduction of catheter-based interventional approaches to treating coronary artery disease, prompted apparently, by a desire to protect what had been exclusively their turf. Reasonable surgeons now largely accept the concept of nonoperative mechanical treatment of coronary heart disease, and their constructive criticisms regarding amelioration of coronary anatomy without thoracotomy remains valuable. The value of catheter-based techniques compared with operative or noninterventional treatment has not been defined in many clinical settings. The complexity of evaluating these rival technologies increases as the complexity of cases progresses from simple 1-vessel disease to more extensive coronary artery disease. Ongoing randomized trials may help define indications for these procedures, but patients entering these trials represent a highly select subset. Therefore, applications to broader patient populations will likely require analysis of observational data. Newer catheter-based technologies introduce modes of injury to the coronary arterial system that have not been encountered previously in medical practice. As technologies evolve, decisions about the need for operative intervention become increasingly complex. In the many clinical settings resulting from efforts to improve angioplasty, optimal patient care occurs in environments with good communication and cooperation between all physicians involved in interventional treatment of coronary artery disease.
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