Directional coronary atherectomy in acute myocardial infarction

George Dangas, Roxana Mehran, Srinivas Duvvuri, Raghuraman Vidhun, John A. Ambrose, Samin K. Sharma

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Balloon angioplasty (percutaneous transluminal coronary angioplasty, PTCA) is an established common strategy in the treatment of acute myocardial infarction (MI) with high success rates but a 5-10% incidence of reclosure/reinfarction due to thrombus and/or intimal flaps. Directional coronary atherectomy (DCA) by removing plaque/thrombus and achieving larger postprocedural luminal diameter may further decrease the incidence of reclosure/reinfarction, with a resultant better in-hospital outcome in this setting. We analyzed the clinical, procedural and in-hospital outcome of patients who underwent DCA or PTCA within 48 h of MI. Long lesions (> 20 mm), large angiographic intracoronary thrombus, lesions in a bend, heavy calcification, and vessel diameter < 3.0 mm were excluded from the study. Although slow flow occurred more frequently during DCA (17 vs. 9% during PTCA, p = 0.04), procedural success (< 50% final diameter stenosis with TIMI-3 flow) was achieved in 96% of DCA and 92% of PTCA group (nonsignificant). Acute closure occurred in 9% of the PTCA group versus 2% of the DCA (p = 0.05), and the composite endpoint of in-hospital reinfarction, reintervention, bypass surgery or death was present in 9% of PTCA cases versus none of DCA cases (p = 0.03). There were no major peripheral vascular complications requiring surgery in either group. Therefore, DCA appears safe and effective in selected patients with recent MI, and is associated with a low incidence of major clinical complications.

Original languageEnglish
Pages (from-to)63-66
Number of pages4
Issue number1
StatePublished - Jul 1998


  • Angioplasty
  • Atherectomy
  • Complications
  • Myocardial infarction
  • Revascularization


Dive into the research topics of 'Directional coronary atherectomy in acute myocardial infarction'. Together they form a unique fingerprint.

Cite this