Percutaneous Coronary Interventions: Current Innovations and Future Perspectives

Percutaneous coronary intervention (PCI) has undergone remarkable evolution over the past decades, leading to substantial improvements in procedural success, patient outcomes, and long-term prognosis, although significant challenges remain. Recent technological and therapeutic advances are reshaping contemporary PCI practice. In acute coronary syndromes, novel thrombectomy approaches and emerging reperfusion strategies aim to improve myocardial salvage. In chronic coronary syndromes, the increasing adoption of intracoronary imaging, advanced calcium modification technologies, drug-coated balloons, and next-generation bioresorbable scaffolds is driving the transition toward more individualized and less implant-dependent revascularization strategies. Parallel developments in antithrombotic therapy, including shortened dual antiplatelet therapy (DAPT) regimens, aspirin-free approaches, and personalized treatment algorithms, seek to improve the balance between ischemic protection and bleeding risk. Furthermore, growing recognition of coronary microvascular disease has expanded the focus of PCI beyond epicardial stenoses, highlighting the importance of functional assessment and targeted therapeutic strategies. Finally, artificial intelligence (AI) is emerging as a transformative tool with potential applications in procedural planning, imaging interpretation, physiological assessment, and clinical decision-making. This review summarizes the most relevant contemporary innovations in PCI and discusses future perspectives that are likely to redefine the management of coronary artery disease.