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Technology of current dilatation systems and methodological procedures.

To fully exploit the advantages of modern dilatation systems, a state-of-the-art X-ray apparatus is of importance. It should be combined with a high resolution video chain with still-frame capabilities for guidance during the intervention. The trend in guiding catheters has moved to more flexible instruments (8 F) with preserved torque control and soft tips. This allows a more active manipulation of guiding catheters. Modern coronary guidewires leave little to be desired: their floppiness can be selected according to the problem to be solved. Long guidewires or extendible guidewires permit balloon exchanges without renegotiation of the stenosis. Very thin guidewires (0.010 in. or 0.25 mm) have been produced for low profile balloons. Special balloon catheters like the Tandem balloon, the Mainz continuous perfusion balloon, and the Doppler tip balloon may be useful in particular cases. Entirely different balloons systems like the Monorail system (only the balloon is riding on the guidewire) or the Omniflex system (the curvature of the balloon tip is shapeable from the outside), may become the standard equipment in some centers. Permanently implanted endoluminal stents may be a solution to the problem of acute occlusion and restenosis, if their promising initial results can be confirmed or even improved.