When should directional or excisional atherectomy be used?
Dr. Ohki: When we talk about excisional atherectomy today, we are primarily discussing the FoxHollow SilverHawk, although there are other atherectomy catheters like the Pathway (Pathway Medical Technologies Inc., Redmond, WA) and the CSI device (Cardiovascular Systems Inc., St. Paul, MN) on the horizon. I think the SilverHawk is a great device. The primary advantage is that it does not leave behind any foreign body. I have had a number of patients come back with in-stent restenosis, and excisional atherectomy works well in this setting as well, although once in a while, the blade gets caught on the stent strut. Whenever I deal with in-stent restenosis, the pre-existing stent always gets in the way of any other effective treatment. One way to address it is to put another stent or a covered stent, but sooner or later, you run out of real estate in the vessel. With atherectomy, you leave nothing behind, so hypothetically, you can repeat this as many times as you want. In fact, when I perf
