Since its inception in the 1960s, coronary revascularization has established itself as a fundamental
therapy for treating the acute and chronic manifestations of atherosclerotic
coronary disease.
Catheter-based techniques were realized in the late 1970s and have evolved from balloon dilatation of simple, discrete
stenoses to complex, multivessel interventions across the spectrum of
coronary disease presentations. In retrospect, there were two defining technological developments the introduction of coronary stenting which enabled more stable acute outcomes and the evolution of
drug-eluting stents which ameliorated the effect of neointimal
hyperplasia the dominant cause of delayed loss of efficacy. The role of
catheter-based intervention in multivessel disease is well established in the treatment of
ST-elevation myocardial infarction and
acute coronary syndromes. On the contrary, in the arena of in stable
coronary disease, its utility is keenly debated. The pace of development in cardiovascular pharmacology has rendered early investigation of best treatment strategies largely obsolete, while newer revascularization techniques have successfully extended the remit of
catheter-based multivessel intervention strategies to include left main stem disease, bifurcation
stenosis and chronic occlusions. Consequently complete revascularization is now available via a percutaneous approach and conventional beliefs relating to choice of revascularization strategy deserve re-assessment. The authors present a contemporary review of the literature and a challenge against fallacies in its interpretation.