How has the use of percutaneous coronary intervention (PCI) evolved?

Updated: Nov 27, 2019
  • Author: George A Stouffer, III, MD; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Answer

Since the first human percutaneous transluminal coronary angioplasty (PTCA) procedure was performed in 1977, the use of percutaneous coronary intervention (PCI) has increased dramatically; it is now one of the most commonly performed medical interventions. Originally developed in Switzerland by Andreas Gruentzig, PCI has transformed the practice of revascularization for coronary artery disease (CAD).

Coronary angioplasty, initially used in the treatment of patients with stable angina and discrete lesions in a single coronary artery, currently has multiple indications, including unstable angina, acute myocardial infarction (AMI), and multivessel CAD. With the combination of sophisticated equipment, experienced operators, and modern drug therapy, PCI has evolved into an effective nonsurgical modality for treating patients with CAD. Ongoing technical advances are allowing more patients with chronic total occlusions (CTOs) to be successfully treated percutaneously.

Improvements in catheter technique and the development of new devices and medications have paralleled our growing understanding of cardiovascular physiology, the pathogenesis of atherosclerosis, and the response to vascular injury. Intracoronary stents and atherectomy devices have been developed to increase the success and decrease the complications of conventional balloon dilation, as well as to expand the indications for revascularization. Interventionalists now can safely treat more complex coronary lesions and restenosis.

The development of drug-eluting stents (DESs) has substantially reduced the problem of restenosis seen with bare-metal stents (BMSs). At the same time, advances in intravascular ultrasonography (IVUS), optical coherence tomography (OCT), and fractional flow reserve (FFR) evaluation have improved the understanding of coronary plaque morphology, plaque vulnerability, and coronary physiology.

Furthermore, many of these technologies are able to help identify patients who will benefit most from PCI, coronary artery bypass grafting (CABG), or medical therapy. Adjunctive pharmacologic therapies aimed at preventing acute reocclusion have also improved the safety and efficacy of PCI.

The growth of PCI has been remarkable. Stents are now used in more than 80% of PCI cases in the United States. This prominent use of stents will be sustained they result in improved outcomes. Over the past two decades, innovations in PCI have been paralleled by dramatic reductions in 30-day death, myocardial infarction (MI), and target-vessel revascularization rates. (See Unstable Angina.)


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