[Interventional cardiology].
Percutaneous intervention, both coronary and noncoronary, is one area of medicine that has experienced significant progress in recent years. This article does not attempt to present an exhaustive review of all the publications that have appeared in the field in the last year, but is rather intended to summarize those which have had the greatest impact on daily practice. The controversy about drug-eluting stents (DESs) revived in the last year with the emergence of copious data that has, finally, demonstrated that DESs can reduce the need for revascularization at the expense of a slight increase in the rate of late stent thrombosis, though without a significant increase in mortality. Nonetheless, the patients who will benefit most must be carefully selected and double antiplatelet therapy must be continued for at least a year. The debate about the use of percutaneous coronary intervention (PCI) for unprotected left main coronary artery stenosis remains open while the results of randomized clinical trials comparing it with surgery are awaited. For the treatment of bifurcation lesions, it appears that implantation of a single stent, when possible, provides the optimum approach. The treatment of chronic total occlusions continues to provide a real challenge for PCI, though both the number treated and the success rate are increasing. The use of DESs and new antiplatelet drugs, which are safer but no less effective, is revolutionizing the treatment of non-ST-elevation acute coronary syndrome. Moreover, the role of primary PCI is increasingly being recognized in the treatment of acute myocardial infarction, as is the importance of reducing the door-to-balloon-angioplasty time. However, there are well-founded doubts about the safety of DESs in this setting. There has been a significant increase in the use of closure devices for closing patent foramen ovale in the past year, and there have been reports of possible benefits in patients with migraine.
Albarrán
Agustín
A
Unidad de Hemodinámica, Hospital 12 de Octubre, Madrid, España. aalbarran58@hotmail.com
Pinar
Eduardo
E
Baz
José A
JA
Mauri
Josepa
J
D054058:Acute Coronary Syndrome / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000175:diagnosis / Q000628:therapy*; D054855:Drug-Eluting Stents; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy