Chronic stable angina revascularization percutaneous coronary intervention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor(s)-In-Chief: ; John Fani Srour, M.D.; Jinhui Wu, M.D.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview
Percutaneous coronary intervention for coronary artery disease first began in 1977, as a valuable mode of revascularization, wherein at the point of coronary stenosis a catheter-borne balloon is inflated to relieve the stenosis.

Advantages
The advantages of PCI for the treatment of CAD are many and include:
 * Low level of procedure-related morbidity and mortality rate in properly selected patients
 * Shorter hospital stay
 * Early return to activity
 * Overall feasibility of multiple procedures

Disadvantages
The main disadvantages of PCI are: During clinical evaluation for treatment, these disadvantages must be considered and may limit the usage of this procedure
 * Risk of acute coronary occlusion during PCI
 * Increased incidence of restenosis in lesions that were successfully treated.

Indications
Ideal candidates for PTCA/PCI include patients:
 * Less than 75 years of age with stable angina
 * With single-vessel and/or single-lesion CAD
 * Without a history of diabetes
 * With objective large ischemia - in particular, lesions less than 10 mm, readily accessible, concentric, and discrete are best suited for revascularization by PCI

Contraindications
On the contrary, chronic total occlusions that cannot be crossed, lesions greater than 20 mm, tortuous, irregular, angulated, calcified, severely stenotic with one or more lesion greater than 90% stenosis present in an artery are associated with an increased risk of morbidity and mortality from the procedure. In addition, PCI is used with reservation in diabetics with multi-vessel disease and in patients with unprotected left main stenosis. Other important factors include the operator volume and the presence or absence of onsite cardiovascular surgeon.

Primary Success
Primary success of coronary intervention is generally defined as an absolute increase of 20% points in the luminal diameter and a final diameter obstruction of less than 30%. Such angiographic success can be anticipated in more than 90% of properly selected patients.

Over the years, alternative methods of percutaneous treatment developed include the use of:
 * Intracoronary brachytherapy for in-stent restenosis.
 * Cutting balloon with metal razors to avoid the spillage and subsequent reduction in the incidence of vessel trauma.
 * Burr rotablation that pulverizes the atheromatous material.
 * Intracoronary stents designed to maintain the lumen size.

Vote on and Suggest Revisions to the Current Guidelines

 * The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines

Guidelines Resources

 * The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina


 * Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology


 * TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina


 * The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina