Interventional cardiology. The decade ahead.

B alloon angioplasty, arguably cardiology's most important advance of the decade past, now suffers from what we will call the 5-45-50 problem: 5% acute closure,' 45% restenosis,2,3 and 50% unsuitable coronary anatomy. We are now beginning to see the first publications describing multicenter experiences with three types of devicesatherectomy, lasers, and stents-originally designed to reduce the 45% restenosis rate. None have thus far clearly demonstrated an effect on either this problem or the acute complication rate, but the wonderful irony is that they apparently will have an important impact on the 50% problem. Thus, while none of the devices may replace balloon angioplasty, it now seems likely that several will occupy specific niches in interventional cardiology. As reported in this issue of Circulation, Ellis et al relate procedural success with directional atherectomy to stenosis location and morphology,4 thus establishing the first clear niche for one of the devices.