Introduction to Coronary Angioplasty

It has been 45 years since Dr. Grüntzig inflated a balloon in the stenosed left anterior descending coronary artery of a patient with angina pectoris, introducing percutaneous coronary intervention (PCI) in clinical practice. Since then, significant breakthroughs in techniques and equipment have expanded the indications of PCI. The goal of PCI is to alleviate patients’ symptoms and reduce major adverse coronary events. Careful preoperative evaluation and continuous monitoring of the patient throughout the intervention are imperative. In the majority of cases, radial artery is the preferred site of access since it has been associated with a reduction in complications and increased survival compared to femoral artery. Specialized catheters are used for the engagement of coronary arteries ostia. Through the catheter, a dedicated 0.014″ wire, whose characteristics are carefully selected based on the anatomy of the target lesion, is advanced to the coronary artery tree and crosses the stenosed segment using as a rail over which balloons and stents will be advanced. Meticulous lesion preparation with balloons and, if needed, with adjunctive devices is the key to success. Stent implantation takes place in essentially every PCI with drug-eluting stents having substituted completely bare-metal stents for every clinical scenario. Functional assessment of intermediate lesions with fractional flow reserve (FFR) or non-hyperemic indices will guide further management (proceed with PCI or defer). Intravascular imaging, namely intravascular ultrasound (IVUS) and optical coherence tomography (OCT), facilitates stent sizing and optimization, making PCI more precise and potentially improving its outcomes.