Primary balloon dilatation for every coronary stenosis?

The introduction of coronary balloon angioplasty launched interventional cardiology. The first 18 years saw significant technical refinements of the dilatation catheters. Balloon catheters remained the primary instrument for coronary angioplasty in spite of the arrival of various new devices. Only the stent has proved really advantageous. The marked increase of coronary angioplasty procedures worldwide is based on two facts. First, coronary artery disease is being detected increasingly earlier. Second, early states of coronary artery disease are treated invasively more and more often. Today, the majority of coronary angioplasty procedurs is performed in patientes who would have been treated medically a decade ago. The dominant role of coronary bypass surgery in true triple vessel disease has not been challenged. The tendency to perform coronary angioplasty in early coronary disease can only be justified if the method remains simple or gets even more simple and cost efficient. The increasing frequency of angioplasty procedures done during the diagnostic study is tending in that direction, as does the decreasing diameter of the material used. At present, there is no coronary situation where a new device should be used rather than a balloon catheter. Therefore, simple and complex cases should be attempted with a balloon first. New devices should only be used in case of a failure of the balloon. A frequent failure of balloon dilatation is a menacing dissection for which the stent is the therapy of choice. The need for the remaining new devices is very small (e.g., rotablator or laser for unpassable or uncrackable stenoses) or non existent.