"All of my PCI cases have been more complicated, higher risk and more difficult than" 1 Why does every interventional cardiologist feel that way? Can it be true? The trends in percutaneous coronary intervention (PCI), like many other trends in medicine, are continuously evolving. Preferred procedural access has been modified to favor transradial access over femoral access. PCI sophistication has improved, with the advent of advanced imaging technology – intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Drug-eluting stents (DES) have become more deliverable and techniques for optimization of deployment have been learned, such as high-pressure balloon dilation for optimal expansion and post-deployment utilization of IVUS or OCT to ensure adequate stent sizing and apposition. The development of ancillary devices, including rotational atherectomy, orbital atherectomy, intracoronary lithotripsy, and plaque-scoring balloons, has enhanced lesion preparation. Adjuvant medication strategies involving anticoagulation and antiplatelet therapy have become more data driven and with better outcomes. Wire technology and delivery catheters have allowed for approaching lesions that were once thought hopeless and providing opportunities for revascularization to those patients who were previously ineligible. Advances in percutaneous mechanical circulatory support have contributed to a greater number of high-risk PCI procedures approached safely. All of these, in addition to improving access to clinical sites where PCI can be performed, have resulted in PCI becoming the most common form of coronary revascularization.