Percutaneous coronary intervention in the 21st century — making surgeons irrelevant?

Interventional cardiology is a rapidly changing area, with technical improvements allowing us to treat an increasing number of clinical situations by percutaneous methods. Indeed, the interface between interventional cardiologist and cardiac surgeon has changed in the past decade, with a dramatic reduction in the need for "rescue" surgery. The most significant recent development has been drug-eluting stents, which have dramatically reduced the rates of restenosis, although at the cost of a need for longer-term antiplatelet therapy after implantation. Failure to continue this antiplatelet therapy may lead to a small but significant excess of stent thrombosis. There have been many other technological improvements, such as distal protection devices and better guidewires for crossing occluded vessels, as well as percutaneous devices for treating valve disease and other structural cardiac abnormalities. These technologies are often best developed in a combined approach with cardiac surgeons, and the selection of the best treatment more than ever requires close cooperation between cardiologist and surgeon.