The pace of change of interventional cardiology continues to accelerate. This process is complex and multifaceted. The pace changes in response to external elements, which include increasingly complex patient and lesion subsets, the dissemination of new sources of information (from randomized clinical trials to live demonstration courses to online continuing medical education [CME]), the availability of new devices, and the promulgation of new guidelines, as well as to internal elements—the drive of creative interventionalists to offer the best therapy to the specific patient at hand, to solve problems, and to extend the possibilities of percutaneous treatment.

In addition, the tools, rationale, and approaches that have been found to benefit so many patients with acute and chronic coronary artery disease (CAD) are being used to treat a plethora of other cardiovascular diseases and other illnesses. Although this book focuses specifically on patients with CAD, many of the messages are transferable and translatable to fields such as carotid arterial disease, renovascular hypertension, left atrial appendage obliteration, and the developing field of percutaneous valve repair and replacement, to name but a few. In addition, current—and increasingly future—interventional cardiologists will be in charge of treating these non-coronary artery diseases, applying the tools and approaches reviewed in this book. These forces will change training programs, the structure of practice, and the flow of patients. In addition, they will impact on other specialties, such as cardiovascular surgery, radiology, and vascular medicine.

In such a rapidly changing field, it is extraordinarily difficult to keep up. In this edition, we have tried to give readers the tools to accomplish that task. These tools include descriptions of new devices and, more importantly, new approaches to problem patients and lesions and clinical scenarios.

We live and practice in an era dominated by drug-eluting stents (DES). With each new meeting, new publication, and new presentation, the data set becomes richer but also more complex. The use of these devices has taken a stereotypical path: (a) small first-in-man experiences in ideal lesions and low-risk patients, (b) somewhat larger registries or small, pilot, randomized trials against either a bare metal stent (BMS) or a competing DES, (c) larger randomized trials with more complex lesions and patients, (d) more “real world” registries of the types of cases seen in day-to-day practice, and (e) the development of new trials to extend the field.