Coronary atherectomy was introduced in 1993 as a way to treat patients with advanced coronary artery disease (CAD). It may be performed in conjunction with other catheter-based procedures such as balloon angioplasty and stenting. 

However, the use of coronary atherectomy is declining as newer angioplasty and stent technologies improve their success rate. Today, coronary atherectomy is performed in only about 3 percent of patients who need coronary intervention. Its use is generally reserved for patients with hard, calcified plaque or unusual lesions in their arteries. In general, studies show that coronary atherectomy does not have better outcomes than the much more common balloon angioplasty, and in some cases may have worse outcomes. As a result, these procedures are generally reserved for specialized situations.

Patients who may be referred for coronary atherectomy include:

• Elderly patients
  
  
• Patients with calcified plaque that is not suitable for conventional angioplasty
  
  
• Patients with unusually large plaque deposits
  
  
• Patients who have undergone angioplasty and stenting but are still experiencing vessel closure
  
  
• Patients with chronic total coronary artery occlusion, a disease characterized by severe and ongoing blockage of the coronary arteries

Patients who are unable to undergo any catheter-based procedure may be recommended for coronary artery bypass surgery, a form of open-heart surgery.

Although patients with CAD may live for years without needing either surgery or a catheter-based procedure, intervention becomes necessary when clogged arteries limit the amount of oxygen-rich blood reaching either the heart or the organs/tissues of the body.

Catheter-based treatments are measured, in part, by the restenosis rate, or how often the coronary vessel re-closes after the treatment. The most common catheter-based treatments used to treat CAD are balloon angioplasty and/or stenting. During a balloon angioplasty, the physician guides a catheter tipped with a balloon into the blocked artery. The balloon is inflated, crushing the plaque against the artery wall and restoring blood flow to the heart muscle. A stent, or very thin metal tube, may be implanted in the artery to help keep it open. Stents dramatically improve the restenosis rate of balloon angioplasty. Newer drug-eluting stents have dramatically improved the restenosis rate.