Atherectomy with the transluminal extraction endarterectomy catheter (TEC) is a new approach for treatment of coronary artery disease, which continues to undergo FDA investigational studies, The major mechanism of the TEC device should be excision of plaque and its removal due to suction applied through an attached vacuum. We report about the acute results in 24 patients treated with TEC atherectomy in native vessels and the outcome of 18 patients who, until recently, underwent follow‐up catheterization after 6 months. The procedure was successful (residual stenosis<50%) in 7 of 24 patients with TEC atherectomy alone (29%); 15 of 24 patients (65%)required additional PTCA in order to achieve angiographic success (10 of 24) or to treat total occlusion (2 of 24) or distal embolization (3 of 24) following atherectomy. One TEC attempt failed due to guiding catheter problems, another major complication was a vessel perforation leading to a non‐Q wave infarction. The minimal residual diameter after passage of the stenosis (prior to additional PTCA) with the 5.5Fr catheter (n = 14) nsas 1.5 ± 0.2 mm, with the 6Fr catheter (n = 9) 1.8 ± 0.4 mm, and 2.2 ± 0.2 mm using the 7Fr catheter (n = 10). The histologic findings revealed intimal cells, fibrous tissue, and homogenate with no identifiable tissue in five cases (21%), whereas in 17 patients (72%) light microscopy could only assess blood cells. Restenosis was present in 9 of 18 patients (50%), occurred in 3 of 7 patients treated with TEC alone, and in 6 of 11 patients treated with TEC + PTCA. The primary underlying mechanism of TEC atherectomy seems to be mechanical dilatation while tissue excision proved to be inadequate to explain the angiographic result. Further studies should be designed to directly compare TEC atherectomy to PTCA in specific patient subgroups (e.g., bypass grafts, intraluminal thrombus, diffuse disease), in order to define the role of this