DIRECTIONAL CORONARY ATHERECTOMY - COMPAR ISON OF EARLY AND RECENT RESULTS

Despite theoretical advantages of Directional Coronary Atherectomy (DC A) vs. PTCA, the first two controlled studies comparing both methods, the Coronary Angioplasty Versus Excisional Atherectomy Trial (CAVEAT): and the Canadian Coronary Atherectomy Trial (CCAT), showed no clinica l benefit of DCA. A second generation of trials, the Optimal Atherecto my Restenosis Study (OARS) and the Balloon versus Optimal Atherectomy Trial (BOAT), designed to optimize DCA with the use of 7F devices and adjunctive PTCA revealed lower angiographic restenosis rates compared to CAVEAT. In addition, the preliminary follow-up results of BOAT, pre sented by Donald S. Baim in Birmingham in August 1996, showed a 20 % r eduction of angiographic restenosis after DCA compared to PTCA. There was no association between post- procedure CK-MB elevation in the DCA group and late mortality. These results may further expand the applica tion of DCA to clinical routine, whereas this procedure still has spec ific indications like treatment of ostial and bifurcation lesions and atherectomy in future may be the treatment of choice for restenosis in coronary stents.