Abstract： In the first decade of the 21 st century,the activities in the American cardiac catheterization laboratories underwent significant changes.From mostly cardiac diagnostic catheterization and basic angioplasty and stenting the procedures became more complex,diverse,involving the peripheral vascular,carotid,renal,aortic,or venous systems.As interventional cardiology is still a young and hyperdynamic playfield,new devices have been constantly developed and new procedures were invented.While these new equipment improved the success,safety of procedures and outcome of patients,they also carried a heavy price tag.