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• W2000757384 abstract "The concept of plaque sealing by coronary balloon angioplasty has been around for some time.1 It is based on two principles. First, a coronary stenosis subjected to balloon angioplasty will not progress to a total occlusion later on unless it occludes abruptly during or immediately after the intervention. Even if a restenosis occurs, the smooth inner lining of the intimal proliferation virtually precludes endothelial rupture and thrombosis. Second, preventing plaque rupture and occlusive thrombosis impacts on the occurrence of myocardial infarction and death. Normalising the blood flow in a significantly stenosed coronary segment only addresses symptoms such as angina pectoris and perhaps exertional dyspnoea. The uncontested benefit of balloon angioplasty, namely alleviation of angina2 deals with a lifestyle problem (physical performance, elimination of medications) but not with the prognosis. Hence, restricting indications for coronary angioplasty to flow limiting lesions means barking up the wrong tree by ignoring what really counts—prevention of coronary occlusion and its devastating effects.The plaque sealing principle has not been widely followed in spite of its theoretical appeal, mainly because of lack of documentation that balloon angioplasty indeed prevents subsequent myocardial infarction. For obvious reasons, such a strategy needs to be restricted to conspicuous and discrete narrowings in proximal segments of major coronary arteries. This may be a 60% 10 mm long stenosis in a proximal left anterior descending, dominant left circumflex, or large right coronary artery. Long lesions or lesions involving complex bifurcations may have a higher intervention risk than potential benefit over several subsequent years. Moreover, the principle cannot necessarily be extrapolated to coronary stenting with its small but significant bane of subacute thrombosis unknown to plain balloon angioplasty.As outlined in the two previous reviews, the unstable plaque, the target of plaque sealing, exhibits a number of specific characteristics. The fibrous …" @default.
• W2000757384 created "2016-06-24" @default.
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• W2000757384 date "2004-12-01" @default.
• W2000757384 modified "2023-10-16" @default.
• W2000757384 title "Plaque sealing by coronary angioplasty" @default.
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• W2000757384 doi "https://doi.org/10.1136/hrt.2004.034983" @default.
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