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[Successful directional coronary atherectomy after futile attempts at balloon dilatation].

Coronary arteriography revealed severe stenoses of the proximal part of the anterior interventricular branch with normal ventricular function in two patients (aged 42 and 38 years) with stable angina and ischaemia reaction in the exercise ECG. In the first patient it was a short spur-like 80% narrowing. But percutaneous balloon angioplasty failed to change the angiographic appearance. In the other patient there was an eccentric, apparently elastic, 90% stenosis, about 10 mm long. Here, too, balloon angioplasty had failed. Subsequently directional coronary atherectomy in both patients achieved removal of the stenosis with lasting clinical improvement. Atherectomy should be considered in similar cases after failed balloon dilatation.