Impact of directional atherectomy on adjacent branch vessels

Balloon angioplasty of bifurcation stenoses may lead to sidebranch compromise, particularly when the sidebranch is diseased and has its origin in the parent vessel occlusion.1 Although the risk of sidebranch compromise may be reduced with the use of ≥2 protective coronary guide wires,3,4 it is not eliminated.2–4 Balloon angioplasty often results in plaque shifting from the parent vessel to the sidebranch, yielding a suboptimal angiographic result; in some cases, simultaneous (“kissing”) inflations of balloons positioned in the parent vessel and sidebranch may be needed.3,4 Directional atherectomy, which partially or completely excises the obstructive plaque, has been used as an alternative method of therapy, avoiding the “snowplowing” effect of balloon angioplasty. The feasibility of directional atherectomy of bifurcation lesions was recently reported.5 However, the incidence and risk factors for sidebranch compromise after directional atherectomy have been less clearly defined. To examine these issues, the clinical course of 60 patients undergoing directional coronary atherectomy of bifurcation lesions was reviewed.