Résumé
Percutaneous transluminal coronary angioplasty is now applied to patients with unstable acute ischemic syndromes, complex coronary morphology, severe multivessel coronary artery disease and impaired left ventricular function. In order to minimize the risk during angioplasty, several coronary and systemic circulatory support approaches have been developed as adjunct to complex and high risk angioplasty. Local coronary support techniques include perfusion balloon catheter, coronary stent, directional coronary atherectomy, laser balloon angioplasty, perfluorocarbon coronary perfusion, coronary sinus retroperfusion and distal coronary hemoperfusion. Systemic circulatory supports include intraaortic balloon counterpulsation, cardiopulmonary support, hemopump and left heart partial bypass. These support devices, while associated with significant complications, may ultimately improve the safety of coronary angioplasty and allow its application to those who would otherwise not be candidates for revascularization