Patients with bothersome stable angina who do not achieve sufficient relief with medical therapy are candidates for coronary angioplasty, if they have any of the following:
1. One coronary artery obstructed (greater than 75%) by a discrete, preferably noncalcified atheromatous plaque without complex angiographic characteristics. Patients with symptoms and obstruction of the left anterior descending artery or right coronary artery before the artery gives off the first branch are the most ideal candidates. Procedural success rate exceeds 97% with these candidates and is associated with a low risk of early complications.
2. A broad range of obstructive lesions including obstruc¬tions in two and three arteries. This is now possible with increased experience and new steerable catheter systems. Success is less likely to occur in patients with obstruction in the circumflex artery or at lower points (distal) in the coronary arteries where there are irregular bends or turns.

B. Acute Heart Attacks
Patients with acute heart attacks may have the clot dissolved by drugs such as streptokinase or tissue-type plasminogen activator (t-PA); or they may undergo coronary angioplasty to dilate the obstructed artery and insertion of a stent. Often coronary angioplasty with stent implantation is performed without the use of thrombolytic agents. Several randomized clinical trials indicate that this aggressive interventional technique is superior to the use of thrombolytic agents, and it is advocated in centers that have facilities for rapid angiography and trained personnel for PCI (see the chapter Heart Attacks).

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