Acute and long-term outcome of failed percutaneous transluminal coronary angioplasty treated by directional coronary atherectomy

Since its initial performance, balloon percutaneous transluminal coronary angioplasty (PTCA) has been limited by a small but finite incidence of acute coronary dissection. This can result in abrupt vessel closure, usually managed with urgent coronary artery bypass grafting. Despite improvements in equipment, technique, and operator experience, the need for urgent bypass after PTCA has remained relatively stable at 2% to 5%, due in part to the expanding indications of the procedure and its use in patients with more complicated conditions and lesions.[1] Techniques that have been used to stabilize acute coronary dissections and avoid emergency coronary bypass surgery include repeat PTCA balloon inflations, prolonged balloon inflations with perfusion balloons,[2,3] laser balloons,[4] and permanent and temporary stenting.[5,6] The recent availability of directional coronary atherectomy (DCA) has made possible an additional technique for the acute treatment of coronary dissection.[7] The purpose of this report is to assess both the acute and long-term efficacy of directional coronary atherectomy for the treatment of failed PTCA due to refractory abrupt closure.