ABSTRACT
This chapter introduces readers to the technique of atherectomy, which can be utilized alone, or as an adjunct in preparing a diseased vessel for a better response to balloon angioplasty or stenting. Atherectomy is unique in its approach to atherosclerotic disease in that it actually removes plaque from a vessel, rather than achieving luminal gain from compressing and fracturing these plaques through radial force. These devices generally approach vessel debulking via one of several mechanisms: orbital, directional/excisional, rotational/aspirational, or photo-ablative (laser). While the chapter does specifically state that there is a lack of level 1 evidence to guide which device should be used in what circumstances, as well as to the efficacy of these devices, it does offer some general guidance on where these devices have been shown to be effective in treating certain lesion types. Regardless, these devices are important tools that are widely available to treat diverse lesions and reduce the need for lesion stenting.
