Historical overview and future perspective of the percutaneous coronary intervention with special emphasis on the development of coronary stent

Abstract

Percutaneous coronary intervention (PCI) using balloon technology and stent implantation has revolutionized the interventional cardiology since the late 1970s. The plane old balloon angioplasty (POBA) was first proposed in the late 1970s as an alternative to coronary artery bypass grafting (CABG) for the treatment of coronary artery disease (CAD) such as angina pectoris and acute myocardial infarction (AMI). Thereafter, bare metal stent (BMS) was designed to overcome the problems proposed by POBA such as acute occlusion and restenosis of coronary target lesion. However, a new problem of BMS-induced in-stent restenosis (ISR) has appeared, and drug-eluting stent (DES) was introduced to resolve the problem of ISR. DES has improved the clinical outcome of patients undergoing PCI. Contemporary stent technology shows remarkable progress, and further effort continues to improve the design, structure, and materials of DES. However, DES has proposed a new problem of very late stent thrombosis. To overcome this late complication, non-stent strategy is introduced into the PCI. This article aims to review the historical development and future perspective of the PCI especially focusing on the evolution of DES.