Directional coronary atherectomy in unstable angina
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Updated: Oct 20, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
A E Abdelmeguid1, S G Ellis, S K Sapp
1Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195.
Insights
Directional coronary atherectomy outcomes differ significantly in unstable angina patients compared to stable angina. Unstable angina patients, particularly those with rest or postinfarction symptoms, face higher complication risks during percutaneous interventions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Unstable angina presents higher risks for angioplasty compared to stable angina, likely due to thrombus-associated plaque.
- Directional coronary atherectomy (DCA) is a percutaneous intervention used to treat coronary stenosis.
Purpose of the Study:
- To compare the outcomes of directional atherectomy in patients with unstable angina versus stable angina.
- To assess if excising complex, ulcerated plaque in unstable angina improves procedural risk.
Main Methods:
- A study of 287 patients undergoing DCA for single-vessel stenosis.
- Patients were categorized into three groups: stable angina (Group I, n=77), unstable angina without rest/postinfarction symptoms (Group II, n=110), and unstable angina with rest/postinfarction symptoms (Group III, n=100).
Main Results:
- Major ischemic complications were significantly higher in Group III (7%) compared to Group I (1.3%) and Group II (0.9%) (p=0.036).
- This difference was primarily driven by a higher incidence of emergency bypass surgery in Group III (5%, p=0.05).
- At a mean 22-month follow-up, Group III showed a higher rate of hospital admission for angina (p=0.05) and trends toward more bypass surgery and myocardial infarction, with no difference in repeat interventions.
Conclusions:
- The definition of unstable angina is crucial for predicting immediate directional atherectomy outcomes.
- In the absence of rest or postinfarction angina, immediate results are comparable to stable angina.
- Atherectomy's impact on immediate and short-term outcomes in unstable angina is less significant than the underlying pathophysiology, which increases percutaneous intervention complications.
Objectives:
To determine whether excision of complex, ulcerated plaque improves the risk of patients with unstable angina to the level of those with stable angina, the results of directional coronary atherectomy were compared in patients with these two syndromes.
Background:
The procedural results of angioplasty in the setting of unstable angina are not as favorable as those observed for chronic stable angina, presumably because thrombus-associated plaque augments the risk of abrupt closure.
Methods:
Two hundred eighty-seven consecutive patients who had undergone directional atherectomy for a single new stenosis were studied. Seventy-seven patients had stable angina (Group I); 110 patients had progressively worsening angina in the absence of rest or postinfarction angina (Group II); and 100 patients had rest or postinfarction angina, or both (Group III).
Results:
Major ischemic complications (death, Q wave infarction, emergency bypass surgery) occurred more frequently in Group III (1.3% [Group I] vs. 0.9% [Group II] vs. 7% [Group III], p = 0.036). This difference was largely due to a higher incidence of emergency surgery in Group III (1.3% [Group I] vs. 0% [Group II] vs. 5% [Group III], p = 0.05). Clinical follow-up was obtained in 97% of successful procedures for a mean follow-up period of 22 months (range 9 to 52) and revealed a higher incidence of hospital admission for angina (p = 0.05) and a trend toward more bypass surgery (p = 0.09) and myocardial infarction (p = 0.16) in Group III. There was no difference in repeat percutaneous interventions among the three groups (range 19% to 24%, p = 0.75).
Conclusions:
These results show that the definition of unstable angina is important in determining the immediate outcome of directional atherectomy. In the absence of rest or postinfarction angina, the immediate results are not significantly different from those obtained in stable angina. Our results also suggest that both the immediate and short-term outcome in unstable angina are not greatly influenced by atherectomy but more so by the pathophysiology of unstable angina, which increases the complications of percutaneous interventions.
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