Angioplasty has matured into a cornerstone of cardiovascular care. A view from outside the field will perceive angioplasty as a routine operation where an artery is widened, a stent is placed, and the patient is discharged. For that matter, angioplasty is fraught with adverse possibilities at almost every step: restenosis-to-go; the stent could fail; the very procedure could harm. Although any of these very harmful possibilities could erase months or multiple years’ worth of benefits. As the volume of angioplasties climbs in 2025, so does the demand for safety, precision, and durable results.

Recent clinical trials and registries have honed in on success and identified gaps that remain. At the EuroPCR 2025 meeting, new three-year data from the BIOADAPTOR RCT (445 patients in 34 centres) showed a target lesion failure (TLF) rate of 2.7% for the DynamX bioadaptor device versus 7.2% for a conventional DES. Death from cardiac causes also occurred less often (0.5% versus 3.2%). 

Another global endeavour is the SELUTION Global Coronary Registry, which aims to accrue up to 10,000 patients so as to judge the real-world results of a drug-eluting balloon over five years. Initial data suggest that long-lasting lumen patency occurs with low late complications.

From market analyses, the global drug-eluting stent market is expected to cross USD 6.5 billion in 2025, with an annual growth rate of around 4%. Hospitals increasingly prefer DES over older stents, driven by improved designs, thinner struts, and biodegradable polymers.

These findings matter for hospital systems, device manufacturers, and clinical leadership because they show what is possible and what is no longer acceptable.

What Makes Angioplasty Safer and Smarter

Based on experience and the recent data, key factors shift outcomes.

1. Advanced devices and innovation

Modern devices like bioadaptors reduce adverse events by optimising vessel compliance post-stenting. Drug-coated balloons (DCBs) demonstrate efficacy in reducing target lesion and target vessel revascularisation and major adverse cardiovascular events, particularly in in-stent restenosis scenarios.

2. Precision through Imaging and Intra-operative Feedback

Intravascular imaging, via IVUS (Intravascular Ultrasound) or OCT (Optical Coherence Tomography), provides real-time insights into plaque morphology, stent expansion, and vessel wall integrity.

Randomised controlled trials (RCTs) support the routine use of IVUS/OCT guidance, showing improved stent deployment, reduced underexpansion, and better long-term outcomes. By combining imaging with modern devices, cardiologists can achieve precision outcomes that were previously unattainable.

3. Outcome measurement and real-world evidence

Complex or heavily calcified lesions can compromise stent deployment. Techniques such as Rotational Atherectomy (Rotablation), Intracoronary Lithotripsy (IVL), and Intracoronary Laser Treatment allow safe lesion preparation, optimising stent expansion and improving procedural success. These techniques are widely available in advanced cardiac centres and are supported by clinical data demonstrating improved outcomes in real-world practice.

4. Training, process discipline, and follow-up

Registries like SELUTION, Ultimaster, and e-Ultimaster (37,198 patients) provide benchmarks for performance across diverse patient populations, lesion types, and operator experience. Hospitals now rely on real-world evidence rather than just idealised clinical trial data to guide practice.

5. Training, process discipline, and follow-up

Even the best devices fail if procedural execution is suboptimal. Smarter angioplasty requires:

• Correct stent sizing, pre-dilatation, and post-procedure imaging
• Structured team training, simulation, and peer review
• Rigorous follow-up and risk factor management (diabetes, hypertension, lipids)

What Hospitals and Industry Leaders Should Do

For device companies, regulators, hospital systems, and health ministries, the path ahead demands strategic focus in several domains:

• Inclusive, high-quality evidence generation: Support registries and trials that include complex lesions, diverse patient populations, and variability in resources.
• Device innovation plus cost effectiveness: Devices that reduce adverse events even slightly can ultimately lower repeat procedures and reduce the cost of care. Hospitals must evaluate total cost (device cost + repeat intervention risk + hospital stay), not just the upfront price.
• Standard protocols with flexibility: Protocols must ensure critical steps, such as imaging, stent deployment quality, and postoperative care, while also allowing for adaptation in settings with limited resources.
• Training and skills retention: Continuous professional development, simulation, team training, structured feedback systems.
• Post-procedure tracking and feedback loops: Hospitals must consistently collect outcomes, review complications, and communicate findings back to operators and procurement teams.

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What Smarter Looks Like in 2025 and Beyond

Smarter angioplasty integrates advanced devices, intravascular imaging, plaque modification techniques, trained personnel, disciplined processes, and real-world data. With lower failure rates, better stent deployment, and carefully prepared lesions, hospitals can reduce readmissions, mortality, and cost variability.

The field is entering a new era where technology and discipline, innovation and training, evidence and execution converge. Angioplasty will be safer, smarter, and more patient-centric, narrowing the gap between what is possible and what is common. Every patient deserves precision, safety, and durable results—2025 shows that this is no longer a vision but a reality.

Views expressed by: Dr. Rajpal Singh, Director – Interventional Cardiology, Fortis Hospital, Bannerghatta Road, Bengaluru

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Disclaimer: The views and opinions expressed in this article are solely those of the author and do not necessarily reflect the official policy or views of any organisation. The content is intended for informational and educational purposes only and should not be construed as medical advice.

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