Mechanical rotational atherectomy.

Percutaneous transluminal coronary angioplasty (PTCA) is practiced widely in the United States and is indicated for the majority of stenosed vessels that have de novo, type A lesions. Despite extensive experience with the procedure and improvements in balloon technology, periprocedural dissection and restenosis remain major limitations of PTCA. Research indicates that certain lesion types and patient populations may be treated more effectively with other technologies. New mechanical devices have been designed to help improve the safety of PTCA and hold promise for correcting coronary dissection and abrupt closure--the sources of such angioplasty complications as myocardial infarction, urgent bypass surgery, and death. Among the results achieved with the new atherectomy techniques are a more stable lumen after atherectomy; a decrease in elastic recoil; a smoother, less thrombogenic lumen; and the feasibility of extensive debulking or endarterectomy. Experience indicates that mechanical rotational atherectomy will be an extremely useful addition to the armamentarium for percutaneous revascularization.