Percutaneous transluminal coronary angioplasty or coronary by-pass surgery in the management of chronic angina pectoris

The treatment modalities for patients with chronic stable angina have expanded since the introduction of percutaneous revascularization procedures such as percutaneous transluminal coronary angioplasty. In selected patients, these percutaneous procedures provide an excellent alternative to surgical revascularization; in other patients, percutaneous transluminal coronary angioplasty is an excellent alternative to medical therapy. Selection of the optimal therapy depends on the specific coronary anatomy, left ventricular function, clinical setting, and the need for complete revascularization. Also, the availability of bailout devices, such as stents for the dilatation procedure, needs to be considered in higher risk patients or higher risk lesions. Currently, randomized trials that are being completed will allow comparison of surgical versus angioplasty approaches and will improve our ability to tailor therapy for specific subsets of patients.