Coronary atherectomy: An essential tool for specific indications.

Technological advances in the manufacturing of stents have extended the ind ications of angioplasty and considerably reduced the immediate complication s, death and myocardial infarction. Nevertheless, intra-stent restenosis re mains a problem and some complex lesions are still inaccessible. Atherectomy has not been shown to be effective in limiting restenosis but i t has a primordial role in the treatment of lesions of bifurcation and coul d improve long-term results as a complement of angioplasty and stenting. Rotational atherectomy is still useful, even essential, for lesions which c annot be passed with the balloon and for calcified plaques of atheroma. A p ossible new indication may be the treatment of intra-stent stenosis. The in dications of directional atherectomy are more limited, mainly non-calcified ostial stenosis and of bifurcations of large arteries. The association wit h 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.