Directional Coronary Atherectomy

  • David R. HolmesJr.


Recognition of the limitations of coronary artery balloon angioplasty fostered the development of nonballoon approaches to percutaneous coronary revascularization. Directional coronary atherectomy (DCA), which received US Food and Drug Administration (FDA) approval in 1990, was the first such technique to be widely applied. The basis for this technique was directionally controlled resection and removal of atheromatous plaque (Fig. 7–1). DCA, which was limited to proximal and midcoronary arterial sites and saphenous vein grafts, produced a larger and smoother lumen than that achieved with conventional balloon angioplasty, and it was hoped that this improved result would translate into fewer complications and even potentially less restenosis. However, initial randomized trials [1–5] comparing DCA with balloon angioplasty for the treatment of de novo native coronary artery lesions (CAVEAT [Coronary Angioplasty Versus Excisional Atherectomy Trial] and CCAT [Canadian Coronary Atherectomy Trial]) did not show significantly better long-term results with DCA; indeed, initial hospital stay was complicated by more non-Q-wave infarctions in the DCA group [1,2].


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Adelman A, Cohen E: A comparison of directional atherectomy with balloon angioplasty for lesions of the left anterior descending coronary artery. N Engl J Med 1993, 329:228–233.PubMedCrossRefGoogle Scholar
  2. 2.
    Topol EJ, Leya F, Pinkerton CA, et al.: A comparison of directional atherectomy with coronary angioplasty in patients with coronary artery disease. N Engl J Med 1993, 329:221–227.PubMedCrossRefGoogle Scholar
  3. 3.
    Holmes, DR, Topol EJ, Adelman AG, et al.: Randomized trials of directional coronary atherectomy: implications for clinical practice and future investigation. J Am Coll Cardiol 1994, 24:431–439.PubMedCrossRefGoogle Scholar
  4. 4.
    Holmes DR, Topol EJ, Caveat-II Investigators: A multicenter, randomized trial of coronary angioplasty versus directional atherectomy for patients with saphenous vein bypass graft lesions. Circulation 1995, 91:1966–1974.PubMedCrossRefGoogle Scholar
  5. 5.
    Holmes DR: Historical background and lessons learned from early randomized trials. Semin Interv Cardiol 2000, 5:163–165.PubMedGoogle Scholar
  6. 6.
    Simonton CA: Directional coronary atherectomy: optimal atherectomy trials and new combined strategies with coronary stents. Semin Interv Cardiol 2000, 5:193–198.PubMedGoogle Scholar
  7. 7.
    Simonton CA, Leon MB, Bairn DS, et al.: ‘Optimal’ directional coronary atherectomy: final results of the Optimal Atherectomy Restenosis Study (OARS). Circulation 1998, 97:332–339.PubMedCrossRefGoogle Scholar
  8. 8.
    Bairn DS, Cutlip DE, Sharma SK, et al.: Final results of the Balloon vs Optimal Atherectomy Trial (BOAT). Circulation 1998, 97:322–331.CrossRefGoogle Scholar
  9. 9.
    Suzuki T, Hosokawa H: Effects of adjunctive balloon angioplasty after intravascular ultrasound-guided optimal directional coronary atherectomy: the result of adjunctive balloon angioplasty after coronary atherectomy study (ABACAS). J Am Coll Cardiol 1999, 34:1028–1035.PubMedCrossRefGoogle Scholar
  10. 10.
    O’Rourke DJ, Malenka DJ, Robb JF, et al.: Results of directional coronary atherectomy in northern New England. Am J Cardiol 1997, 79:1465–1470.PubMedCrossRefGoogle Scholar
  11. 11.
    Kiesz AS, Rozek MM: Acute directional coronary atherectomy prior to sterling in complex coronary lesions: ADAPTS Study. Cathet Cardiovasc Diagn 1998, 45:105–112.PubMedCrossRefGoogle Scholar
  12. 12.
    Bramucci E, Angoli L, Merlini PA, et al.: Adjunctive stent implantation following directional coronary atherectomy in patients with coronary artery disease. J Am Coll Cardiol 1998, 32:1855–1860.PubMedCrossRefGoogle Scholar
  13. 13.
    Moussa I, Moses J, Colombo A: Atherectomy plus stenting: what do we gain? Semin Interv Cardiol 2000, 5:217–225.PubMedGoogle Scholar
  14. 14.
    Moussa I, Moses J, Di Mario C, et al.: Stenting after optimal lesion debulking (SOLD) registry: angiographic and clinical outcome. Circulation 1998, 98:1604–1609.PubMedCrossRefGoogle Scholar
  15. 15.
    Boehrer JD, Ellis SG, Pieper K, et al.: Directional atherectomy versus balloon angioplasty for coronary ostial and non-ostial left anterior descending coronary artery lesions: results from a randomized multicenter trial.J Am Coll Cardiol 1995, 24:1380–1386.CrossRefGoogle Scholar
  16. 16.
    Ellis SG, Tamai H, Nobuyoshi M, et al.: Contemporary percutaneous treatment of unprotected left main coronary stenoses: initial results from a multi-center registry analysis 1994–96. Circulation 1997, 96:3867–3872.PubMedCrossRefGoogle Scholar
  17. 17.
    Dauerman HL, Higgins PJ, Sparano AM, et al.: Mechanical debulking versus balloon angioplasty for the treatment of true bifurcation lesions.J Am Coll Cardiol 1998, 32:1845–1852.PubMedCrossRefGoogle Scholar
  18. 18.
    Palacios IF, Sanchez PL, Mahdi NA: The place of directional coronary atherectomy for the treatment of in-stent restenosis. Semin Interv Cardiol 2000, 5:209–216.PubMedGoogle Scholar
  19. 19.
    Haberbosch W, Waas W, Waldecker B, et al.: Directional coronary atherectomy of in-stent restenosis: a two-center experience.J Intervent Cardiol 2000, 13:93–100.CrossRefGoogle Scholar
  20. 20.
    Douglas JS Jr.: Balloon angioplasty: matching technology to lesions. In The Practice of Interventional Cardiology, edn 2. Edited by Vogel JHK, King SB III. St. Louis: Mosby-Year Book; 1993:85.Google Scholar
  21. 21.
    Douglas JS Jr.: Percutaneous strategies for management of angina pectoris following coronary bypass surgery. In State-of-the-Art of Invasive Cardiology: Current Diagnostic and Therapeutic Issues. Edited by Vetrovec GW, Carabello BA. Mount Kisco, NY: Futura Publishing Company; 1996:483–499.Google Scholar
  22. 22.
    Douglas JS Jr.: Percutaneous coronary intervention after bypass surgery. In Handbook of Cardiovascular Intervention. Edited by Bertrand M, Serruys P, Sievart U. London: Churchill Livingstone; 1996.Google Scholar

Copyright information

© Springer Science+Business Media New York 2003

Authors and Affiliations

  • David R. HolmesJr.

There are no affiliations available

Personalised recommendations