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(Circulation. 2007;116:232.)
© 2007 American Heart Association, Inc.

Editors' Note

Gregg W. Stone, MD; Patrick W. Serruys, MD, PhD; Antonio Colombo, MD

Series Editors, Advances in Interventional Cardiology, Circulation

An extract of the first 250 words of the full text is provided, because this article has no abstract.

September 16, 2007, marks the 30th anniversary of the first percutaneous coronary balloon angioplasty procedure by Andreas Gruentzig, a seminal event that has forever altered the therapeutic landscape for patients with coronary artery disease. From its initial application, restricted to patients with a single obstructive lesion in the proximal coronary tree, angioplasty rapidly spread to higher-risk and more complex patients, such as those with multivessel disease, chronic total occlusions, and acute myocardial infarction. Physicians and patients rapidly embraced this newer, less invasive technique. However, it quickly became evident that balloon angioplasty was severely limited by acute and subacute vessel closure in 5% to 10% of patients and by restenosis in as many as 50% of cases. The introduction of the bare metal stent in the mid 1980s virtually eliminated acute closure and further reduced restenosis rates by one third, but these stents were not without their own issues. Vascular injury produced by stents resulted in excessive neointimal hyperplasia with in-stent restenosis in approximately one third of patients, which was occasionally refractory to repeat angioplasty (necessitating vascular brachytherapy and other arcane approaches). Moreover, the stainless steel implant elicited subacute thrombosis with resultant death or myocardial infarction in as many as 16% of patients in the early reports, which has gradually been reduced to 1% with improved stent technique and adjunct pharmacology. Finally, the site-specific delivery of antiproliferative agents to the region of vascular injury with drug-eluting stents has further lowered restenosis to <10% in most patients, though the infrequent but concerning . . . [Full Text of this Article]