Angioplasty after thrombolysis.

The article by Meyer et al.' (Circulation 66: 905, 1982) presents exciting, well-documented treatment of patients with successful thrombolysis followed,by immediate angioplasty. The average area stenosis of the reported successes was reduced from 90.2 ± 7.3% to 58.6 ± 19%. These results parallel our own in routine angioplasty and selected post-thrombolysis patients. How disappointing, then, to read Dr. Swan's following editorial where he recommends that lesions of 75% cross-sectional narrowing (area) are suitable for angioplasty, whereas lesions greater than 90% should be managed surgically. This appears quite contradictory. Putting aside the confusion produced by diameter reduction methods vs area methods, it is simply not true that the severity of stenosis limits angioplasty improvement in Meyer's article. Almost all of our current angioplasty candidates have at least 90% area stenosis (75% diameter reduction), and good results are usually seen. Unfortunately, we have already heard well-meaning cardiologists quote Dr. Swan's editorial and withhold angioplasty because the lesion appears to be "over 90%.." Perhaps Dr. Swan could clarify his editorial and provide some documentation for his statements. MA-rrHEW L. CARR, M.D. Florida Medical Center Lauderdale Lakes, Florida