Hula-Hoops, Pet Rocks And Intravascular Brachy Therapy

During the past 25 years, we have seen dramatic changes in the management of patients with coronary artery disease. The introduction of coronary angioplasty, or balloon dilatation, by Gruentzig in 1977 heralded a fundamental breakthrough in the treatment of patients with obstructive coronary artery disease.1 Now termed percutaneous coronary intervention (PCI), more than one million patients per year are treated worldwide, making PCI the most commonly performed therapeutic procedure in adult medicine.2 Despite remarkable chronological developments that refined the safety and effectiveness of PCI, its Achilles heel was the vexing problem of restenosis, a rapid (within six months) growth of scar tissue, or neointima, within the PCl-treatment site. Most of the 25-35% of patients who experienced restenosis ultimately needed a repeat PCI or coronary bypass operation. In light of its frequent occurrence, restenosis limited the application of PCI to patients with predominately single- or double-vessel coronary artery disease.3 While hundreds of adjunctive medical therapies and specialized PCI catheter technologies such as laser and atherectomy were tested over the years in an attempt to curb restenosis, none were successful. The introduction of coronary artery stents vastly improved PCI safety, yet stenting resulted in only a minor reduction of restenosis.4