ABSTRACT
Percutaneous coronary intervention (PCI) was made possible by the pioneering work of Andreas Gruentzig, who in 1977 performed the first angioplasty procedure. Ongoing innovations in procedural techniques, interventional devices, and pharmacology continue to expand the indications and treatment options for PCI. The ACC/AHA lesion classification scheme has been used to predict the success rate and risk of PCI for specific anatomic subsets. PCI of friable thrombotic and/or atherosclerotic lesions can result in plaque fragmentation and distal embolization. Most contemporary PCI procedures, including final kissing balloon inflation (FKBI) and small burr rotational atherectomy (RA), can be performed with 5or 6-Fr guiding catheters. Distal protection devices, including occlusion balloons or filters, trap and retrieve atheroemboli distal to the lesion. Atherectomy or atheroablative devices are applicable in specific anatomic subsets such as calcified or thrombotic lesions, either as stand-alone therapy or, more commonly, as pretreatment to facilitate stent deployment.
