Percutaneous interventions for ischemic heart disease.

In the United States, when necessary due to symptoms or prognosis, percutaneous coronary interventions are performed on patients with ischemic heart disease more frequently than is coronary artery bypass surgery. A wide array of options are available to the interventional cardiologist. Improvements over the 17 years that coronary balloon angioplasty has been performed have kept it the primary therapy. It is currently used safely and effectively in the majority of patients. The problems of abrupt closure, restenosis, and inadequate results in some complex lesions have spurred the development of intracoronary stents, coronary atherectomy and ablation devices, and coronary excimer lasers. Metallic stents perform well in large vessels to treat abrupt closures and to reduce restenosis, but confer a risk of hemorrhage. Specific complexities of lesion characteristics determine the effective use of atherectomy/ablation devices and lasers. Future technologic improvements anticipate even better treatments for patients with coronary artery disease.