Specialized revascularization devices in the management of coronary heart disease
- Donald Cutlip, MD
Donald Cutlip, MD
- Section Editor — Interventional Cardiology
- Professor of Medicine
- Harvard Medical School
- Beth Israel Deaconess Medical Center
The management of coronary heart disease (CHD) has evolved significantly due in part to improvement in both surgical and percutaneous revascularization techniques. While the majority of patients with chronic stable angina are treated with medical therapy, revascularization on top of medical therapy is the preferred treatment strategy in many clinical subgroups. (See "Stable ischemic heart disease: Indications for revascularization".)
The majority of patients who undergo revascularization receive percutaneous coronary intervention (PCI) with stenting, as opposed to coronary artery bypass graft surgery (CABG). (See "Revascularization in patients with stable coronary artery disease: Coronary artery bypass graft surgery versus percutaneous coronary intervention".)
Most patients who undergo PCI receive stents. Specialized revascularization devices such as rotational atherectomy (for severely calcified lesions) or laser angioplasty (for in-stent restenosis) have been evaluated in clinical trials.
Neither short- nor long-term benefits have been shown consistently with these revascularization devices. In particular, atherectomy devices have generally failed to improve patient survival or the durability of the revascularization [1,2]. These findings indicate that ROUTINE use of specialized device therapies (over the combination of balloon dilation and stent implantation) is not justified.
The use and efficacy of rotational atherectomy, cutting balloon atherectomy, and excimer laser angioplasty will be reviewed here. The complications associated with their use are discussed separately. (See "Coronary complications of atheroablative devices".)
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- ROTATIONAL ATHERECTOMY
- Calcified and complex lesions
- Use prior to stenting
- Internal mammary artery graft stenosis
- Saphenous vein graft lesions
- Use in diabetic patients
- In-stent restenosis
- Adjunctive therapy with abciximab
- Rotational atherectomy summary
- ORBITAL ATHERECTOMY
- CUTTING BALLOON ANGIOPLASTY
- EXCIMER LASER ANGIOPLASTY
- Efficacy for in-stent restenosis