New Frontiers in Percutaneous Interventions

Abstract

In 1977 Andreas Gruntzig introduced a catheter-based therapy for the percutaneous management of patients with coronary artery disease. This became known as percutaneous transluminal coronary angioplasty (PTCA). Initially there were many skeptics and pessimists. The technology, however, evolved rapidly. With the advent of specialized catheters, guidewires, stents, and adjuvant pharmacotherapy, the indications for PTCA have expanded to include more urgent, comorbid cases and complex coronary disease. Furthermore, these innovations have largely solved earlier problems related to elastic recoil, dissection and restenosis of the treated segment. In particular, the introduction of stents with the capacity to elute drugs to the injured arterial wall has been shown to be an effective and overall safe approach to suppress intimal hyperplasia. The excellent results of DES in clinical trials and everyday clinical practice, in synergy with important improvements in adjuvant drug therapy, have expanded the indications of percutaneous coronary interventions even further. Within 10 years of its introduction, the number of PTCA procedures has surpassed the number of revascularizations accomplished by coronary artery bypass graft surgery.