Percutaneous Coronary Intervention - Academic Plumbers Unlimited Est. 1977

Professor Anthony Gershlick
Department of Cardiovascular Sciences

Lecture Summary

Percutaneous coronary angioplasty (PCI)  has become the dominant therapy for the treatment of atheromatous flow limiting coronary lesions. In the UK there are 3-4 PCIs for every bypass operation and in parts of Europe this reaches 6-8:1. PCI is less invasive than coronary artery bypass grafting but has always needed to demonstrate equal efficacy in all patients including the most complex. The road to where we are now with PCI (3 million worldwide procedures, has been littered with pitfalls, be they the risk of needing urgent surgery in the early days of balloon angioplasty alone, to the evolution of first bare metal stents, with their inherent propensity to develop platelet centric thrombus, to the drug eluting stent revolution again with the need through large trials to show efficacy compared to bare metal stents and to CABG. Worries regarding late stent thrombosis with DES have to a large degree been resolved but ongoing proof of efficacy in terms of need for a repeat intervention is still lacking when compared to surgery in patients with the most complex disease and in diabetics. On the way The Cardiac Department at UHL has been instrumental in almost all aspects of the development of PCI. Bench studies to evolve new drugs on new stents, involvement in large clinical trials and development of the Regulatory process through NICE have occupied our interest. As for the future dealing with heart attacks using PCI is now established but the correct adjunctive pharmacotherapy is unclear and again we have been involved in these developments. The future holds promise for stem cell delivery and the development of biabsorbable stents - we are involved in both through pre-clinical and early clinical work.

My inaugural lecture will chart the development of PCI and our contribution to its success.