Canadian Journal of Cardiology

The ongoing saga of the evolution of percutaneous coronary interventions: From balloon angioplasty to recent innovations to future prospects


      The advances in percutaneous coronary interventions (PCI) have been, above all, dependent on the work of pioneers in surgery, radiology and interventional cardiology. From Grüntzig’s first balloon angioplasty, PCI has expanded through technology development, improved protocols, and dissemination of best-practice techniques. We can nowadays treat more complex lesions in higher-risk patients with favourable results. Guidewires, balloon types and profiles, debulking techniques such as atherectomy or lithotripsy, stents and scaffolds all represent evolutions that have allowed us to tackle complex lesions such as an unprotected left main coronary artery, complex bifurcations, or chronic total occlusions. Best-practice PCI, including physiology assessment, imaging, and optimal lesion preparation are now the gold standard when performing PCI for sound indications, and new technologies such as intravascular lithotripsy for lesion preparation, or artificial intelligence, are innovations in the steps of 4 decades of pioneers to improve patient care in interventional cardiology. The present review describes major innovations in PCI since the first balloon angioplasty and also uncertainties and obstacles inherent to such medical advances.
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