In cases of atherosclerosis in which there is minimal calcification or occlusion, balloon angioplasty and stent placement are effective in restoring blood vessel patency, or openness. However, these methods alone are ineffective at treating advanced calcified atherosclerotic vessels due to arterial hardness, forcing over 200,000 people per year in the U.S. to seek more aggressive treatment.

The gold standard for debulking calcified lesions in the coronary arteries is atherectomy, which involves the use of razors, drills, and lasers threaded on intra-arterial catheters to ablate calcified plaque as a precursor to stenting.

There are three main types of plaque modification and ablation techniques emplyed by current market atherectomy systems: directional, rotational, and orbital Examples of these are displayed with their respective coronary and peripheral complication rates in the figure below. Directional atherectomy utilizes a cutting device that moves longitudinally within the artery to shave away the calcified lesion into a collection tube. However, this method is so dangerous that it is not approved for use in the coronary arteries. Rotational atherectomy employs a high speed rotating burr coated with microscopic diamond particles to drill away at the calcified lesion. Orbital atherectomy utilizes a similar type of abrasive burr that orbits eccentrically around a central axis. The major drawbacks of these techniques are difficulty in navigating the devices through tortuous vasculature as well as risks of vessel perforation and distal embolization. The relatively high rates and severity of these complications require that interventions take place in hospitals in which cardiac surgeons are available to perform emergency surgery to mitigate the effects of these complications, which include internal bleeding and myocardial infarction.