Local drug delivery for percutaneous coronary intervention

Abstract

Since the first successful coronary angioplasty by Andreas Grüntzig in 1977, the field of percutaneous coronary intervention (PCI) has expanded rapidly. Rapid technological refinement has seen equipment and complementary pharmacotherapy to improve the outcome of PCI evolve dramatically, driven by clinical need and enormous market forces. The ideal intervention should expand the vessel lumen without inflicting endothelial injury, and provide local drug delivery to prevent subsequent acute thrombosis and neointimal hyperplasia. Drug eluting stents, once regarded as the "gold standard" in PCI, and established as the treatment of choice for nearly a decade, remain limited in their performance by important risks of in-stent restenosis and late stent thrombosis. In this review, we discuss need for local drug therapy as an adjunct to angioplasty and present exciting new technological advances to deliver local pharmacotherapy to the coronary artery, which will hopefully overcome some of the limitations of DES and may represent the way forward in coronary intervention.