Lesion-specific technique considerations in directional coronary atherectomy.

Directional coronary atherectomy (DCA) has expanded over the past several years to include treatment of a wide variety of complex coronary lesions in difficult vessel locations. Ulcerated, eccentric, and hazy lesions; ostial, mid, distal, and bifurcation lesions; saphenous vein graft lesions; tandem and long lesions; and "rescue" of failed angioplasty lesions are all potentially well-suited for DCA. This paper describes a lesion-specific strategy for DCA and outlines equipment selection and techniques helpful for performing DCA in a broad range of cases.