Abstract
Percutaneous intervention, whether coronary or noncoronary, continues to be a highly active area of medicine. This article contains an overview of the most notable developments reported in recent months. Drug-eluting stents (DESs) have provided one of the major advances in interventional cardiology as they have very effectively reduced the restenosis rate. Both randomized clinical trials and large observational studies have confirmed their safety, and their use has been extended to include highly complex conditions. Although thrombosis is one complication that can affect both conventional stents and DESs, the rate of late stent thrombosis is slightly, though significantly, higher with DESs. Primary angioplasty is the treatment of choice for patients with acute myocardial infarction if carried out under appropriate conditions, within a reasonable time period in a specialized center by experienced personnel. Use of thrombectomy devices can improve procedural outcomes and it appears that DES implantation is safe and effective, though more data are still needed. In patients with non-ST-elevation acute coronary syndrome, early treatment using an invasive approach coupled to the administration of various combinations of antiplatelet and antithrombotic drugs continues to be fundamental. Although left main coronary artery lesions are generally treated surgically, advances in percutaneous techniques and the use of DESs mean that an increasing number of patients are being treated using percutaneous coronary interventions. A number of studies have shown good results in other lesions and in high-risk patients with, for example, bifurcation lesions, chronic occlusions or diabetes. Intracoronary ultrasound is the predominant intracoronary diagnostic technique and it can be used to assist in optimizing DES implantation. In addition, measurement of the fractional flow reserve is helpful in evaluating the severity of moderate lesions whereas the high-resolution images provided by optical coherence tomography are particularly informative. Multislice computed tomography enables the presence of coronary artery disease to be ruled out and the technique is also useful as a complementary tool for interventional cardiologists. Research into regenerative techniques is promising but remains experimental at present. With regard to noncoronary interventions, new data have become available that support the use of a percutaneous approach in patients with patent foramen ovale. In addition, clinical experience with percutaneous aortic valve replacement, via either the transfemoral or transapical route, is increasing.
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