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The problem of restenosis after coronary angioplasty has led to the development of many alternatives that promise better long-term success. Two randomized, multicenter trials compared balloon angioplasty with an increasingly used technique: directional atherectomy.
A study in the U.S. and Europe involved 1012 patients with symptomatic coronary disease documented by angiography. Atherectomy was slightly more likely than angioplasty to eliminate significant stenosis (89 vs. 80 percent of patients), but it had a 13 percent higher cost and carried a higher rate of early complications (11 vs. 5 percent), primarily abrupt vessel closure and acute myocardial infarction. At 6 months, the atherectomy group had a slightly lower restenosis rate (50 vs.…