PERCUTANEOUSE CORONARY INTERVENTION

HISTORICAL PERSPECTIVE

Balloon angioplasty was first performed by Andreas Gruentzig in 1977 with a fixed-wire balloon catheter.

By rapidly evolving operators experiences and equipment design border spectrum of patients with more complex lesion are undergoing PCI.

Major advancesThe major advances in interventional cardiology continue as new technology is developed,tested,and brought to the clinical arena.These advances have led to the significant increase in procedural volume so that currently,the number of PCI exceeds the number of CABGs.

THE TECHNIQUE OF BALLOON DILATATION

A guide wire is passed across the stenosis

This is followed by deflated balloonThe balloon catheter is inflated within

the lesionThe lumen is enlarged after balloon

removal

BALLOON ANGIOPLASTY

The improvement in luminal diameter of vessel is mainly due to cracking of the vessel wall that frequently extends through the plaque and the underlying media,allowing expansion of both the inner and outer diameter of the treated segment.

TWO MAJOR LIMITATIONS OF

BALLOON ANGIOPLASTY : *Abrupt vessel closure 2-8% *Restenosis 30%-50%

THE NEW CORONARY DEVICES TO IMPROVE UPON PROCEDURAL OUTCOMES ACHIEVED WITH BALLOON ANGIOPLASTY:

Removing devices: Directional atherectomy

Extraction atherectomy

Debulking devices: Excimer laser angioplasty

Scaffolding device: Stents

Rotational atherectomy

STENTS(scaffolding devices)

Coronary stents have fundamentally changed the practice of interventional cardiology by reducing early complication(abrupt vessel closure) and improving late clinical outcome(restenosis) and it is estimated that 50-80 percent of PCI procedures now involved the use of stent.