Catheter Intervention: Balloon Angioplasty

Abstract

Dotter and Judkins first described transluminal angioplasty in 1964 ⁽¹⁾. Using a surgical cutdown, they introduced solid cylindrical dilators of sequentially increasing diameters to enlarge the vessel lumen of iliac and femoral arteries. Ten years later Gruentzig ⁽²⁾ successfully applied Dotter’s concept to a percutaneously placed inflatable noncompliant balloon, demonstrating effective dilation of iliac and femoral arteries. In 1975 the technique was applied to the coronary arteries ⁽³⁾. At that time, the prevailing hypothesis of the mechanism of vessel enlargement was redistribution of soft atheromatous plaque. Pediatric cardiologists were therefore slow to apply the technique to congenital vessel stenoses. Animal studies in the early 80s^(4,5,6) showed the mechanism of vessel enlargement by angioplasty to be intimai and medial injury with presumed healing in an open position; the door opened to the rapid application of balloon angioplasty to a variety of congenital vascular stenoses. In a trio of case reports in 1982, Singer et al. reported angioplasty of a coarctation in an infant⁽⁷⁾, Driscoll et al. unsuccessfully dilated pulmonary vein stenosis⁽⁸⁾, and Rocchini et al. treated SVC obstruction⁽⁹⁾. By 1983 the technique had been successfully applied by Lock and colleagues to series of patients with pulmonary artery stenosis, coarctation, and venous stenosis including atrial baffle obstruction ^(10,11,12).