SCAI'S Hildner Lecture traces progress through 30 years of interventional cardiology

(PCI). The procedure is successful in 98 percent of patients, with a rate of major complications of only 1.5 percent. Just 1 patient in 1,000 needs emergency bypass surgery.

Indeed, nearly 30 years after the first balloon inflation in a human coronary artery, interventional cardiology is enjoying unprecedented success, not only in bread-and-butter coronary interventions, but in advanced new catheter procedures once unimaginable to all but the most innovative thinkers.

The path to success has not always been smooth, however. For example, it was once thought that atherectomy would play an important role in treating restenosis by slicing away, boring through, or evaporating with a laser the overgrowth of scar tissue that can renarrow a coronary artery within months of angioplasty. Instead, stentswhich were safer, easier to use, and more effectivecame out ahead, and were soon being implanted in nearly every patient who had PCI.

Stents, however, had their own weakness, namely, in-stent restenosis. For a time it was hoped that radiation therapy inside the coronary artery would be the answer. Instead, drug-eluting stents held the day, and as a result, six-month restenosis rates have fallen from approximately 40 percent in the early days of PCI to just 57 percent today.

Recently, drug-eluting stents have been found to pose a small but definite increase in the risk of blood clotting in the stent, even long after PCI. Interventional cardiologists are hard at work investigating the causes and solutions to the problem of late stent thrombosis.

"One fundamental message is that over the last 30 years, there have been progressive improvements in the success, safety, and durability of PCI as new technologies have been launched," Dr. Baim said. "But as each innovation solved a serious prior problem, it sometimes introduced a rare new adverse event that needed its own solution."

The corollary to that message is that interv

Contact: Kathy Boyd David
Society for Cardiovascular Angiography and Interventions

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