New developments in percutaneous coronary intervention

Since Dr. Andreas Gruentzig performed the first angioplasty procedure in a human in 1977,(39) the technology and techniques of percutaneous coronary i ntervention (PCI) have developed considerably. Until relatively recently, b alloon angioplasty performed in the presence of adjunctive therapy with asp irin and heparin has been the only widely available percutaneous revascular ization modality. A number of new devices have been adopted into everyday c linical practice, including stents, atherectomy catheters, and others. The use of new pharmacologic agents as adjuncts to interventional procedures, p articularly glycoprotein IIb/IIIa receptor antagonists, also has become sta ndard. In addition, although the intra-aortic balloon pump is not a new dev ice, the use of balloon pumps and other circulatory support devices in sele cted highrisk patients undergoing coronary intervention has grown. Patient selection for percutaneous revascularization has changed considerab ly. PCI now is performed commonly in many patients who generally were not t reated with PCI in the past, including patients with acute myocardial infar ction or multivessel disease. Finally, although this article is limited to therapeutic approaches for coronary artery disease, it should be recognized that the scope of percutaneous intervention now extends to procedures invo lving the carotid arteries, peripheral arteries, and the aorta.