Safety of percutaneous coronary atherectomy with deep arterial resection

Percutaneous coronary atherectomy is currently under investigation as an alternative procedure to percutaneous balloon angioplasty for the relief of high grade obstructive lesions. With this method, tissue is mechanically resected from the area of stenosis. Because the depth of resection cannot be controlled with the device used, it is possible to remove not only intimal atherosclerotic material but also deeper arterial structures. In this regard, it is of interest that catheter disruption of the internal elastic lamina in animal studies, with exposure of underlying medial elements, resulted in subsequent thrombotic occlusion of the damaged vessel.¹ Although mechanical resection of tissue by atherectomy may result in the exposure of medial or even adventitial tissues, the risk of deep arterial resections in humans with coronary atherectomy has not been reported.