The directional atherectomy catheter is advanced over a steerable guide-wire. The housing has a 10 mm long window and a supporting balloon on the opposite side. The proximal end has a balloon inflation port, a guide wire port, a lever for movement of the cutter, and an attachment for a motor, spins at 200 rpm.
After correct placement of the window over the lesion and balloon inflation and a cut is performed by slowly advancing the spinning cutter to the distal end of the housing device, thereby packing the shavings into the nose cone of the device.
The balloon is deflated, the window reoriented, and the sequence repeated. Complications include dissection of the coronary artery, thrombus formation, and spasm, which may lead to acute infarction of the heart muscle.

This includes a standard over-the-wire steerable catheter system:

1) Dilatation catheter through which,

2) a steerable guide-wire is placed,

3) a guiding catheter to the coronary artery opening,

4) a balloon pressure device

5) manifolds for selection of constant pressure measurement or for injection of contrast medium or heparinized saline