Percutaneous coronary intervention. I: History and development

The term “angina pectoris” was introduced by Heberden in 1772 to describe a syndrome characterised by a sensation of “strangling and anxiety” in the chest. Today, it is used for chest discomfort attributed to myocardial ischaemia arising from increased myocardial oxygen consumption. This is often induced by physical exertion, and the commonest aetiology is atheromatous coronary artery disease. The terms “chronic” and “stable” refer to anginal symptoms that have been present for at least several weeks without major deterioration. However, symptom variation occurs for several reasons, such as mental stress, ambient temperature, consumption of alcohol or large meals, and factors that may increase coronary tone such as drugs and hormonal change. View this table: Unequivocal indications for use of coronary stents The Canadian Cardiovascular Society has provided a graded classification of angina which has become widely used. In clinical practice, it is important to describe accurately specific activities associated with angina in each patient. This should include walking distance, frequency, and duration of episodes. In the management of chronic stable angina, there are two invasive techniques available for myocardial revascularisation: coronary artery bypass surgery and catheter attached devices. Although coronary artery bypass surgery was introduced in 1968, the first percutaneous transluminal coronary angioplasty was not performed until September 1977 by Andreas Gruentzig, a Swiss radiologist, in Zurich. The patient, 38 year old Adolph Bachman, underwent successful angioplasty to a left coronary artery lesion and remains well to this day. After the success of the operation, six patients were successfully treated with percutaneous transluminal coronary angioplasty in that year. By today's standards, the early procedures used cumbersome equipment: guide catheters were large and could easily traumatise the vessel, there were no guidewires, and balloon catheters were large with low burst pressures. As a result, the procedure was limited to patients with refractory angina, good …