If atherectomy procedures are found to be safe and effective for removal of plaque in human coronary arteries, they can be expected to provide an important alternative to balloon angioplasty for the treatment of many types of coronary lesions. In addition, many patients who are candidates for coronary artery bypass procedures could likely benefit from these less invasive procedures. Although atherectomy has a theoretic potential for reducing the rate of restenosis by removing the plaque rather than pushing it to the side, it is unlikely to eliminate the restenosis problem completely. A more important advantage of atherectomy may be the potential for successful treatment of lesions that are anatomically unsuitable for PTCA. Even though balloon catheter technology has evolved to the point that almost all lesions in the coronary anatomy can be successfully negotiated, approximately half the coronary patients who require invasive therapy in the United States are still undergoing open-heart bypass procedures. Thus, if atherectomy can expand the indications for interventional therapy to the types of lesions that are currently considered unsuitable for PTCA, the large number of patients who are currently unable to benefit from interventional catheterization techniques could be treated. With all the new devices under investigation, carefully controlled prospective randomized trials must be conducted once the developmental phases have been completed. Each new technology must be compared with the current state-of-the-art techniques of balloon angioplasty and coronary artery bypass operation. Finally, all the new procedures and devices must be directly compared with each other to determine the best use of each new technology. The overall clinical value can be assessed only after late angiographic follow-up studies have been performed to determine the long-term benefit in various subgroups of patients who have been treated with these new technologies.
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