[Coronary atherectomy. An essential tool for specific indications].
Technological advances in the manufacturing of stents have extended the indications of angioplasty and considerably reduced the immediate complications, death and myocardial infarction. Nevertheless, intra-stent restenosis remains a problem and some complex lesions are still inaccessible. Atherectomy has not been shown to be effective in limiting restenosis but it has a primordial role in the treatment of lesions of bifurcation and could improve long-term results as a complement of angioplasty and stenting. Rotational atherectomy is still useful, even essential, for lesions which cannot be passed with the balloon and for calcified plaques of atheroma. A possible new indication may be the treatment of intra-stent stenosis. The indications of directional atherectomy are more limited, mainly non-calcified ostial stenosis and of bifurcations of large arteries. The association with stenting has given encouraging results which require confirmation. These techniques have a place in the in the angioplasty physician's arsenal even though they are reserved for specific anatomical situations.
Coste
P
P
IFR Coeur-Vaisseaux-Thrombose Inserm 4, CNRS FR21, CHU de Bordeaux, Bordeaux-Pessac.
Roudaut
R
R
Besse
P
P
Bonnet
J
J
D015906:Angioplasty, Balloon, Coronary; D017225:Atherectomy, Coronary / Q000379:methods*; D003324:Coronary Artery Disease / Q000628:therapy*; D003327:Coronary Disease / Q000628:therapy*; D006801:Humans; D018579:Patient Selection; D012008:Recurrence; D015607:Stents
Athérectomie coronaire. Un outil indispensable pour des indications spécifiques.