Directional atherectomy. New approaches for treatment of obstructive coronary and peripheral vascular disease.

Atherectomy is defined as the controlled removal of atherosclerotic tissue from vessel walls. The directional atherectomy catheter consists of a cup-shaped cutter within a housing unit and a small balloon. It was developed to perform transluminal atherectomy for the treatment of atherosclerotic vascular disease. This new procedure was performed on 195 lesions in peripheral arteries of lower limbs in 134 procedures, and 52 lesions in coronary arteries in 50 procedures. A successful angiographic outcome was obtained in 89% of procedures and 90% of lesions in peripheral experience, and 60% of procedures and 62% of lesions in coronary experience. A higher success rate (81%) was achieved in our more recent experience with coronary atherectomy, as compared with a 42% success rate in our earlier experience. The incidence of major complications was infrequent in both peripheral and coronary experiences. In the peripheral experience, one patient had delayed occlusion that required bypass surgery, and two patients had distal embolization. In the coronary experience, one patient had acute occlusion that required emergency bypass surgery. There were no vessel perforations. Conclusively, transluminal atherectomy is a feasible, predictable, and safe procedure for the treatment of peripheral and coronary artery disease. Further studies, however, are necessary to evaluate the long-term efficacy of this new procedure.