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Coronary complications of atheroablative devices

Joseph P Carrozza, MD
Section Editor
Donald Cutlip, MD
Deputy Editor
Gordon M Saperia, MD, FACC


Coronary atherectomy (directional, orbital, and rotational) and excimer laser coronary angioplasty account for less than 3 percent of current coronary interventions. The low rate of use is due both to the availability of drug-eluting stents and the lack of compelling trial data suggesting that the atherectomy devices offer better outcomes in a standalone or even an adjunctive role, except in cases where fibrocalcific plaque impedes device delivery or balloon expansion.

Coronary atherectomy and excimer laser angioplasty have all of the adverse events associated with other invasive cardiac procedures, such as coronary angiography and other forms of percutaneous coronary intervention. However, the rates of some of these are increased due to the factors related to both the equipment and the procedure. (See "Complications of diagnostic cardiac catheterization" and "Periprocedural complications of percutaneous coronary intervention".)

The uses and efficacy of these devices are reviewed elsewhere. (See "Specialized revascularization devices in the management of coronary heart disease".)


A report from the New Approaches to Coronary Intervention (NACI) registry reviewed data from 3265 patients undergoing revascularization with atherectomy devices or laser [1]. There was a 3.6 percent incidence of non-ST elevation (non-Q wave) myocardial infarction (NSTEMI) and 1.1 percent incidence of ST elevation (Q wave) myocardial infarction (STEMI). The in-hospital MI rates were the same for directional atherectomy, extraction atherectomy, rotational atherectomy, and laser. The major etiologies for MI were coronary embolus and abrupt closure.

The true incidence of myocardial infarction (MI) is higher if assessed by more sensitive assays such as three-fold elevations in serum creatine kinase (CK-MB) or troponin concentrations.

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Literature review current through: Nov 2017. | This topic last updated: Mar 02, 2017.
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  1. Waksman R, Ghazzal ZM, Baim DS, et al. Myocardial infarction as a complication of new interventional devices. Am J Cardiol 1996; 78:751.
  2. Saucedo JF, Popma JJ, Kennard ED, et al. Relation of coronary artery size to one-year clinical events after new device angioplasty of native coronary arteries (a New Approach to Coronary Intervention [NACI] Registry Report). Am J Cardiol 2000; 85:166.
  3. Baim DS. Coronary Angioplasty. In: Cardiac Catheterization, Angiography and Intervention, Baim DS, Grossman W (Eds), Williams & Wilkins, Baltimore 1996. p.551.
  4. Warth DC, Leon MB, O'Neill W, et al. Rotational atherectomy multicenter registry: acute results, complications and 6-month angiographic follow-up in 709 patients. J Am Coll Cardiol 1994; 24:641.
  5. Reisman M, Harms V, Whitlow P, et al. Comparison of early and recent results with rotational atherectomy. J Am Coll Cardiol 1997; 29:353.
  6. Brown DL, Buchbinder M. Incidence, predictors, and consequences of coronary dissection following high-speed rotational atherectomy. Am J Cardiol 1996; 78:1416.
  7. Walton AS, Pomerantsev EV, Oesterle SN, et al. Outcome of narrowing related side branches after high-speed rotational atherectomy. Am J Cardiol 1996; 77:370.
  8. Williams MJ, Dow CJ, Newell JB, et al. Prevalence and timing of regional myocardial dysfunction after rotational coronary atherectomy. J Am Coll Cardiol 1996; 28:861.
  9. Reisman M, Buchbinder M, Warth D, et al. Comparison of patients with either < 70% diameter narrowing or > or = 70% narrowing of the right coronary artery when performing rotational atherectomy on > or = 1 narrowing in the left coronary arteries. Am J Cardiol 1997; 79:305.
  10. Koch KC, vom Dahl J, Kleinhans E, et al. Influence of a platelet GPIIb/IIIa receptor antagonist on myocardial hypoperfusion during rotational atherectomy as assessed by myocardial Tc-99m sestamibi scintigraphy. J Am Coll Cardiol 1999; 33:998.
  11. Piana RN, Paik GY, Moscucci M, et al. Incidence and treatment of 'no-reflow' after percutaneous coronary intervention. Circulation 1994; 89:2514.
  12. Sperling RT, Ho K, James D, et al. Treatment of stent-jailed side branch stenoses with rotational atherectomy. J Invasive Cardiol 2006; 18:354.
  13. Baumbach A, Bittl JA, Fleck E, et al. Acute complications of excimer laser coronary angioplasty: a detailed analysis of multicenter results. Coinvestigators of the U.S. and European Percutaneous Excimer Laser Coronary Angioplasty (PELCA) Registries. J Am Coll Cardiol 1994; 23:1305.
  14. Larrazet FS, Dupouy PJ, Dubois Rande JL, et al. Angioscopy variables predictive of early angiographic outcome after excimer laser-assisted coronary angioplasty. Am J Cardiol 1997; 79:1343.