Principal Findings:

Rotational atherectomy and excimer laser are virtually never stand-alone procedures, particularly if there is a conservative approach to device sizing relative to the arterial reference diameter.

Adjunctive balloon angioplasty is often required to obtain an acceptable residual stenosis and smooth lumen in the target segment.

In a head-to-head comparison, excimer laser catheters more frequently failed to cross the stenosed arterial segment and resulted in more frequent clinical complications than rotational atherectomy devices.

Acceptable angiographic results were obtained with adjunct balloon inflations at relatively low pressures after the use of either atherectomy device. This suggests that these devices may affect plaque compliance in addition to debulking, thereby facilitating balloon angioplasty. Theoretically, low-pressure balloon inflations are less likely to cause excessive procedural dissections; the lower acute complication rates after rotational atherectomy may be evidence of that.

Use of rotational and laser atherectomy provided no benefit on clinical or angiographic outcome, implying that chronic recoil and neointimal proliferation were not prevented by these new device catheters.