Directional coronary atherectomy has shown definite advantages over balloon angioplasty in opening lesions that are very eccentric or at the origin of the LAD. It permits excision and removal of atherosclerotic plaques from proximal and mid-coronary artery sites. Acute occolusion occurs in 4% and restenosis in 30%. Risk perforation 0.7-0.9% of cases. If lesion is not favorable for balloon dilatation (ostia lesions, lesions of complex form, vein graft sites), directional atherectomy may help. These lesions have resulted in the use of stents etc. (see figures 56A, C)