Management of coronary artery disease has substantially improved since the introduction of percutaneous transluminal coronary angioplasty by Doctor Andreas Grüntzig in 1977. Cardiac surgery was the prevailing revascularization strategy at that time, with percutaneous coronary intervention (PCI) reserved to patients with favorable coronary anatomy. Revolutionary changes in technologies have reverted the status quo such that most revascularization procedures are currently performed percutaneously. Introduction of new-generation drug-eluting stents with a superior design to bare-metal stents decreased the rates of complications and recurrent ischemic events on the short- and long-term follow-up. In particular, the incidence of stent thrombosis after PCI has significantly declined over the past years raising questions about the need for prolonged antiplatelet therapy duration. Furthermore, as newer and more potent antithrombotic agents are currently available, the main challenge remains to balance the bleeding and ischemic risks, especially in those that carry high bleeding risk characteristics. Advancements in intracoronary imaging technologies have allowed a more optimal stent deployment and implantation, mitigating the risk of early and late stent failure due to stent fracture and neoatherosclerosis formation. In addition, adoption of state-of-the-art devices, guidewires, and techniques has facilitated the treatment of complex coronary lesions. With a growing population of complex and high-risk patients, new-generation mechanical circulatory support devices have extended PCI indications to patients deemed ineligible for surgical revascularization. In this review series, we provide an overview on the recent advances in PCI, ranging from antithrombotic therapy, intracoronary imaging, treatment of complex lesions, and use mechanical circulatory support devices.
Prof. George Dangas and Prof. Christian Hengstenberg
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