Atherectomy plus stenting: what do we gain?

I. Moussa, J. Moses, A. Colombo

Research output: Contribution to journalReview articlepeer-review


Coronary stents have improved the short and long-term outcomes of selected patients undergoing catheter-based coronary interventions. However, the use of these devices in complex coronary lesions has also created an incessant form of in-stent restenosis that still defies treatment. Plaque burden has been recognized as an important factor that may incite neo-intimal proliferation after stent implantation. Prospective non-randomized experience has shown that plaque removal prior to stent implantation using directional atherectomy is a promising approach to reduce restenosis in selected patients. However, the proof of concept awaits the results of the randomized trials. Ultimately, the clinical utility of this approach will depend upon: (1) further improvements on the current directional atherectomy device; (2) minimizing the incidence of non-Q-wave myocardial infarction with selective use of IIb-IIIa platelet receptor antagonists or distal protection devices; (3) targeting patients at high risk for restenosis in whom efficient debulking is feasible such as non-calcified lesions in vessels >2.75 mm and <3.5 mm in diameter that require long stents, aorto-ostial lesions, bifurcational lesions, and chronic total occlusions.

Original languageEnglish (US)
Pages (from-to)217-225
Number of pages9
JournalSeminars in interventional cardiology : SIIC
Issue number4
StatePublished - Dec 2000
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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