This chapter delves into the dynamic trajectory of interventional cardiology, tracing its evolution through four pivotal technological revolutions: percutaneous transluminal coronary angioplasty (PTCA), coronary stents, drug-eluting stents (DES), and bioresorbable scaffolds (BRS). It offers a nuanced analysis of how these innovations have reshaped therapeutic strategies and altered patient phenotypes over time. Initially limited to low-risk cohorts, interventional procedures have progressively embraced more complex, high-risk populations, including those with heightened bleeding propensities. The chapter examines landmark trials such as LEADERS FREE and DEBUT, which advocate for short-term dual antiplatelet therapy and drug-coated technologies, particularly in high-bleeding-risk populations. Additionally, it addresses the integration of advanced structural interventions like transcatheter aortic and mitral valve replacements and left atrial appendage occlusion (LAAO), underscoring individualized antithrombotic regimens that optimize safety and efficacy. By aligning procedural advancements with evolving patient characteristics, the chapter encapsulates the transition toward precision medicine in interventional cardiology. This paradigm shift emphasizes tailored, patient-specific therapeutic approaches, balancing thrombotic risk mitigation with bleeding management to enhance clinical outcomes across diverse patient populations.