The place of directional coronary atherectomy for the treatment of in-stent restenosis.

The beneficial short and long-term results of coronary stenting have resulted in a dramatic increase in stent utilization, accounting for greater than 80% of coronary interventions [1--9]. However, the long-term beneficial effect of coronary stenting is limited by the occurrence of a 14 to 61% restenosis rate [10--13]. The optimal percutaneous revascularization strategy for the treatment of in-stent restenosis remains undetermined. Although balloon angioplasty has been performed with high initial procedural success, the long-term results are disappointing due to significant recurrence [14--18]. In this article we describe the feasibility, safety, immediate and long-term outcome of directional coronary atherectomy (DCA) as a treatment modality in a cohort of patients undergoing percutaneous intervention for the treatment of in-stent restenosis at the Massachusetts General Hospital.