Percutaneous Coronary Intervention in Ischemic Heart Disease

Park, Seung Jung

Abstract

Catheter-based techniques to treat coronary artery diseases have been developed rapidly during the past half a century. After the first performance in 1977, the percutaneous transluminal coronary angioplasty has attained clinical relevance and become a viable option for medical and surgical treatment in patients with a coronary artery disease. However, the high incidence of acute closure and restenosis following balloon angioplasty limits its widespread use. Among the various medical and technical efforts to prevent the untoward effects of balloon angioplasty, coronary artery stenting was most successful and has been the turning point in the management of coronary occlusive diseases in 1990's. Intravascular ultrasound and doppler pressure wire have facilitated the optimal procedure of coronary stenting. However, the stent restenosis and in-stent restenotic lesion present a new and an even more challenging dilemma due to the widespread use of coronary stent. With better understanding of pathophysiology of stent restenosis, new approaches and therapies are encouraged and provide unique insight in the treatment of restenosis. Intracoronary brachytherapy with beta- and gamma-radiation was successful in decreasing the occurrence of in-stent restenotic lesions. Drug-eluting stents using various antiproliferative drugs are the most exciting modality in preventing restenosis and are currently under clinical trials. Newer percutaneous coronary interventional techniques including gene therapy and targeted drug delivery are also under investigation. This article presents the review of the current practice of percutaneous coronary intervention in the treatment of coronary occlusive diseases.