The ever increasing role of percutaneous interventions in coronary revascularisation.

Balloon angioplasty was developed as the first non-surgical method to treat coronary artery stenosis, thanks to the pioneering work by Andreas Gruentzig from 1977 to 1986. The method is based on mechanical stenosis relief by balloon dilatation. Vessel wall stretch, as well as plaque compaction and redistribution, are the main mechanisms of angioplasty lumen gain. The technique had a relatively high acute vessel closure rate that dictated its performance with standby emergency coronary artery bypass grafting (CABG). Stenosis recurrence four to five months after a successful procedure was relatively frequent, and was common to balloon angioplasty as well as other means of percutaneous revascularisation that developed in parallel. Restenosis after balloon angioplasty was mainly attributed to passive recoil of the initially stretched vessel wall, although plaque increase, later defined as intimal hyperplasia, also played a role. Despite all its shortcomings, percutaneous interventions in the 80s made modification of coronary stenosis with diseased vessel reformation possible for the first time in history. Thanks to this development, patients were offered the option of open arteries, at least in cases without restenosis.