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Updated: Jul 16, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
[Interventional cardiology 2006]
Rosa Ana Hernández Antolín1, Felipe Fernández-Vázquez, José Moreu Burgo
1Unidad de Hemodinámica, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, España. rhernandez_antolin@hotmail.com
Insights
Percutaneous coronary intervention (PCI) is expanding to treat more complex cases, with drug-eluting stents reducing restenosis. Future innovations aim to overcome current limitations and expand PCI applications.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Context:
- Percutaneous coronary intervention (PCI) applications are expanding to include patients with complex cardiovascular disease, comorbidities, and challenging lesions.
- Drug-eluting stents have significantly reduced restenosis rates, improving PCI success in stable patients.
- Despite advancements, PCI faces limitations in treating specific lesions like bifurcations and total occlusions, and its role versus surgical revascularization in left main or multivessel disease requires further definition.
Purpose:
- To review the expanding applications, current limitations, and future directions of percutaneous coronary intervention (PCI).
- To highlight the evolving role of PCI in managing acute coronary syndromes and its comparison with surgical revascularization.
- To discuss emerging technologies and research, including novel stents, integrated treatment networks, and non-coronary interventions.
Summary:
- PCI success rates are high, with reduced restenosis due to drug-eluting stents, yet limitations persist for complex lesions.
- PCI is increasingly preferred over conservative approaches for high-risk acute coronary syndromes and primary angioplasty over thrombolysis for ST-elevation myocardial infarction.
- Future developments include advanced stents, integrated treatment networks for efficient resource utilization, and potential percutaneous treatments for conditions like severe aortic stenosis.
Impact:
- PCI advancements are improving outcomes for a broader range of cardiovascular patients.
- Optimized treatment strategies and networks enhance patient access to timely and high-quality interventional procedures.
- Ongoing research into novel stents, cellular therapies, and non-coronary interventions promises to further broaden the scope and efficacy of percutaneous treatments.
Abstract:
The range of applications of percutaneous coronary intervention (PCI) continues to expand and a growing number of patients are being treated, including those with extensive cardiovascular disease, more serious comorbid conditions, and more complex lesions. Even so, the success rate is high, serious complications are rare in stable patients, and the restenosis rate has been dramatically reduced by drug-eluting stents. Nevertheless, percutaneous techniques still have major limitations restricting their use in some type of lesions, such as bifurcations and total occlusions, and their role in relation to surgical revascularization has not yet been well defined in the treatment of the left main coronary artery or multivessel disease. The development of novel types of coated stent with better mechanical characteristics and a lower risk of occlusion will further expand the ambit of PCI. The role of PCI in the management of acute coronary syndromes is already well defined, and has increased the preference for an invasive rather than a conservative approach in high-risk patients without ST elevation and the preference for primary angioplasty rather than thrombolysis in those with ST elevation. The development and implementation of integrated coronary syndrome treatment networks will enable human and material resources to be used efficiently, and will guarantee rapid access to high-quality PCI for those who need it. The potential usefulness of combining cellular therapy with interventional procedures in the treatment of acute myocardial infarction has still to be determined. At present, there is extensive research into noncoronary interventions, which, in the not too distant future, could provide percutaneous treatment for the many elderly patients with severe aortic stenosis who are not currently eligible for surgery.
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