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Directional atherectomy, rotational atherectomy and coronary stent, followed by coronary bypass operation in a patient with the aggressive restenotic process.

In the era of multiple coronary interventional devices, most lesions can now be treated by a percutaneous technique. Because of these powerful tools, it has become more difficult for the cardiologist to choose between percutaneous revascularization and coronary artery bypass surgery. Recent randomized studies of coronary angioplasty versus bypass surgery have provided insights into the selection of balloon angioplasty versus bypass surgery but did not consider the use of advanced interventional devices such as directional atherectomy, rotational atherectomy or coronary stents.