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(Circulation. 1998;98:1802-1820.)
© 1998 American Heart Association, Inc.

Clinical Cardiology: New Frontiers

Frontiers in Interventional Cardiology

Eric J. Topol, MD; ; Patrick W. Serruys, MD, PhD

From the Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, and the Department of Interventional Cardiology, Thorax Center, Erasmus University, Rotterdam, Netherlands.

Correspondence to Eric J. Topol, MD, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195.

Key Words: revascularization • stents • platelets • restenosis • angiogenesis

In more than 20 years since the first percutaneous coronary revascularization procedures, the field of interventional cardiology has proliferated beyond all expectations. Now more than 1 million procedures are performed worldwide each year. Stenting has revolutionized the field, which previously relied on balloon dilatation in the majority of patients. With 50% of patients now undergoing stent implantation, the groundwork is laid for further important advances. In this article, we discuss the 4 most important new advances in the field of interventional cardiology: platelet inhibition, prevention of restenosis, stent evolution, and angiogenesis.

Platelets

Proximate Cause of Stent Thrombosis
Considerable progress in the field of percutaneous coronary revascularization has been made by appreciation of the pivotal role of platelets and the development of new therapies directed against platelet aggregation. The entire field of stenting was catapulted forward with the realization that subacute thrombosis was predominantly attributable to a platelet thrombus. Since the beginning of coronary stenting in 1986, thromboprophylaxis consisted of full doses of heparin and coumarin, along with aspirin and dipyridamole.^{1 2} This regimen resulted in the necessity for prolonged hospital stays to achieve therapeutic anticoagulation and in excessive bleeding complications and was still ineffective in preventing stent thrombosis in at least 4% to 5% of patients.^{2 3 4 5 6} The prevailing belief was that stent thrombosis, which occurred primarily several days after the index procedure, was due to a fibrin-rich (red) thrombus.^{7 8 9} Many of the cases of stent thrombosis were linked to suboptimal anticoagulation.^{8 9} The complication of stent thrombosis is dreaded, because it may result in myocardial infarction (MI) or . . . [Full Text of this Article]

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