It came as no surprise that coronary balloon angioplasty, a derivative of peripheral balloon angioplasty, instigated balloon angioplasty of renal and cerebral arteries as soon as it was shown to be feasible and reasonably safe. The first renal angioplasty was performed in 1978 in Bern, Switzerland, by Mahler, a former colleague of Gruentzig in the Angiology Division in Zurich, where the latter invented peripheral balloon angioplasty. Gruentzig performed a procedure himself a few days later, again on a patient under the care of one of the authors (B.M.), and was the first to publish it.45 Although the potential of this method to reduce hypertension turned out to be fairly low,46 there is an additional salutary effect on renal function. Stenting as a complement to balloon angioplasty proved helpful in ostial but not in more peripheral renal artery lesions.

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The first angioplasty of a cerebral artery was reported by Sundt and colleagues from Rochester, Minn, in 1980 and pertained to the basilar artery.47 Balloon angioplasty of the cervical carotid artery followed in 1980, first as an adjunct to surgical endarterectomy48 and then in 1983 as a stand-alone percutaneous procedure.49 Carotid stenting was first reported in 1995.50 Stenting has been rapidly adopted as the exclusive percutaneous treatment of carotid artery stenosis.51 It was thought that the dreaded risks of peripheral embolism and also restenosis could be further reduced. However, acute local closure and restenosis with balloon angioplasty alone had never been a real problem in light of the comparatively large diameter of these vessels. Because stents did not eliminate the problem of distal embolization (and because no randomized studies exist, they might even increase it), a variety of mechanical protection systems as well as adjunctive drugs are currently under investigation.