Atherectomy Compared To Balloon Angioplasty
Directional coronary atherectomy offers several theoretical advantages over conventional balloon angioplasty.
By cutting the atherosclerotic plaque rather than stretching and cracking it, directional atherectomy may produce a more predictable, controlled result than balloon angioplasty and reduce the need for emergency bypass surgery.
Moreover, for lesions restricted to one side of a coronary artery (asymmetric lesions), this technology can be directed specifically at the plaque in order to minimize trauma to the remaining normal arterial wall.
Thus far, results of studies evaluating DCA indicate that the success rate for the procedure is not strikingly different from that for conventional balloon angioplasty. However, advocates of the newer procedure assert that most of the patients who have undergone DCA in these studies were at higher-than-usual risk for complications with balloon angioplasty.
Early experience with DCA suggests that it may be useful for several types of "problem lesions" that tend to respond poorly to conventional balloon dilation. For example, many highly asymmetric lesions (which pose a high risk for abrupt closure) can be safely treated with directional atherectomy.
In general, however, none of the newer devices mentioned above have been shown to be uniformly more successful than traditional angioplasty (PTCA), but each may have a particular niche where it is effective.
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