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GUEST EDITORIAL



Rajesh Rajani
RAJESH RAJANI
Twenty years have passed since the beginning of clinical interventional cardiology on the occasion of the first angioplasty procedure performed by Andreas Gruentzig. This discipline which started as an added technique for Physicians who performed cardiac atheterisation has evolved as a specialist branch of cardiology. It has indeed been a fascinating 20 years filled with new discoveries, expanded technology and clinical therapies, and it has stimulated a dramatically increased interest in vascular biology. Because of dramatic technologic developments, many patients can now undergo appropriate revascularisation procedures much less obstructively than was possible in the past. It gives me immense pleasure to edit this issue on interventional cardiology, where topics pertinent to this field have been concisely written by my young friends from across the state and across the globe. What has intrigued me most in the therapeutics of coronary artery disease is re-stenosis. The restenosis process, initially predicted to occur in 30% of patients, became a major problem with angioplasty. Although antiplatelet agents were effective in preventing acute complications, neither antiplatelets nor anticoagulants influenced restenosis rate. Then came fish oils, steroids, colchicine, CCBS, ACE inhibitors and HMG Co-A reductases inhibitors. Although no compound has been documented in large randomised trials so reliably reduce the restenosis rate, several have recently provided some hope. We have a dedicated write up on this from one of my colleagues from Chennai. Because of disappointing results with restenosis trials of systemic therapy, there has been great interest in drug delivery locally. Various balloon delivery systems starting with porous balloon and many other versions, have been used in an attempt to achieve a high local concentration of drugs. To date, none of these methods have proven significantly effective in patients, possibly because of their ineffective drug delivery. Perhaps techniques for sustaining drug concentration in the arterial wall will be achieved in the future. I hope you enjoy reading this edition on interventional cardiology which tackles some controversial topics in this front.

RAJESH RAJANI


 

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