Transcatheter treatment of coronary artery disease

This chapter describes the various methods of percutaneous coronary intervention (PCI), including balloon angioplasty, stenting, thrombectomy, and atherectomy, and the application of intravascular ultrasound. It also illustrates the use of PCI in special cases, as in acute coronary syndromes, acute myocardial infarction, chronic total occlusion, severe calcification of the coronary arteries, and aneurysmal disease. PCI is now the primary method of coronary revascularization. PCI originated as balloon angioplasty, first performed in humans by Andreas Gruntzig in 1978, but it has evolved into a variety of catheter-based methods to treat coronary disease [1]. PCI has revolutionized modern cardiovascular care, enabling patients with myocardial ischemia to be treated less invasively by avoiding a surgical approach. As experience accrued and the technology advanced, the number of patients and angiographic lesion subsets increased dramatically - up to the current era in which PCI is now more commonly performed than coronary artery bypass graft (CABG) surgery. When available and performed in experienced centers by well-trained, expert physicians and teams, it has become the procedure of choice for acute coronary syndromes, acute myocardial infarction, single-vessel coronary artery disease, and many patients with two- and three-vessel coronary artery disease. In addition, it has become the treatment of choice for saphenous vein bypass graft stenoses.