New approaches to reduce recurrent PCI. To angioplasty and beyond!

Despite advancements in percutaneous coronary intervention (PCI), many patients continue to experience recurrent ischemia and require repeat procedures. This review outlines emerging strategies aimed at reducing the need for recurrent PCI and improving cardiovascular outcomes. Technological improvements in stent design—particularly second-generation drug-eluting stents—and adjunctive tools like intracoronary lithotripsy, imaging (IVUS/OCT), and physiological assessments (FFR/iFR) have optimized revascularization. Yet, restenosis and incomplete revascularization persist. Beyond mechanical solutions, lipid-lowering therapies—such as PCSK9 inhibitors, inclisiran, bempedoic acid, and icosapent ethyl—demonstrate significant reductions in major adverse cardiovascular events (MACE) and repeat revascularizations. Additionally, glucose-lowering agents, particularly SGLT2 inhibitors and GLP-1 receptor agonists, offer cardiovascular protection in diabetic patients. Novel agents like tirzepatide, a dual GIP/GLP-1 receptor agonist, are also promising. The article emphasizes a shift toward comprehensive management of residual cardiovascular risk through lifestyle interventions, pharmacotherapy, and tailored revascularization strategies. Interventional cardiologists are urged to integrate these approaches to enhance patient outcomes and limit the burden of recurrent PCI.