Does atherectomy add significantly to the practice of interventional cardiology?

Andreas Gruentzig demonstrated that physicians could nonsurgically 'operate' within the coronary arteries to safely enlarge the lumen of narrowed vessels. Over the past 18 years, the practice of coronary balloon angioplasty [percutaneous transluminal coronary angioplasty (PTCA)] has been extended considerably beyond the initial anatomic indications (single discrete concentric stenoses) to encompass success in a wide variety of lesions and in the presence of unstable clinical conditions. Despite the success, PTCA has several shortcomings that either limit its application or result in undesirable complications. As a result of these limitations, alternative methods for enlarging the lumen of diseased coronary arteries have been developed, including atherectomy devices that effect plaque removal. The question to be answered is whether atherectomy devices can become the primary percutaneous revascularization technique by improving procedure safety and long-term results or whether these will remain important 'niche' devices to be used only for lesions with anatomically unfavorable features for PTCA.