Atherectomy

Definition

Atherectomy is the removal of plaque from coronary arteries and vein grafts.

Description

In general, atherectomy is performed in the cardiac catheterization laboratory under local anesthesia either at the same time as diagnostic coronary arteriography (using dye to determine the extent of coronary artery blockage), or at a later time.

The catheter is usually inserted into a vessel in the patient's groin and threaded through the vessel into the heart and coronary blood vessels.

Types of Atherectomy

Directional coronary atherectomy shaves plaque, which is collected in a nose cone and removed. This procedure may be useful in large blood vessels with odd-shaped, non-calcified lesions.

Rotational atherectomy uses a high-speed rotational burr that is effective in calcified stenoses (narrowing of the vessel).

The transluminal extraction catheter is designed to remove large collections of plaque, often from vein grafts. Using a catheter with a laser at the tip (e.g. excimer laser catheter), doctors can focus rapidly pulsating beams of light that vaporize the tissue into gases that are dissolved in the bloodstream and eliminated in the body's natural waste system. Lasers may be useful in areas where balloons are suboptimal, such as long areas of narrowing.

How Does Atherectomy Work?

A typical atherectomy rotational catheter has a metal cylinder about 1 inch from the tip that contains a rotating disk that spins at 2,500 revolutions per minute. Plaque is exposed to the rotating cutting blade and shaved off. The plaque fragments are stored in a collection chamber in the tip of the catheter until it is withdrawn.

When the collection chamber is full, the cardiologist withdraws the catheter, which can be cleaned and reinserted. The procedure may be repeated four to six times to open the artery adequately.

Atherectomy Compared To Balloon Angioplasty

Directional coronary atherectomy offers several theoretical advantages over conventional balloon angioplasty.

By cutting the atherosclerotic plaque rather than stretching and cracking it, directional atherectomy may produce a more predictable, controlled result than balloon angioplasty and reduce the need for emergency bypass surgery.

Moreover, for lesions restricted to one side of a coronary artery (asymmetric lesions), this technology can be directed specifically at the plaque in order to minimize trauma to the remaining normal arterial wall.

Thus far, results of studies evaluating DCA indicate that the success rate for the procedure is not strikingly different from that for conventional balloon angioplasty. However, advocates of the newer procedure assert that most of the patients who have undergone DCA in these studies were at higher-than-usual risk for complications with balloon angioplasty.

Early experience with DCA suggests that it may be useful for several types of "problem lesions" that tend to respond poorly to conventional balloon dilation. For example, many highly asymmetric lesions (which pose a high risk for abrupt closure) can be safely treated with directional atherectomy.

In general, however, none of the newer devices mentioned above have been shown to be uniformly more successful than traditional angioplasty (PTCA), but each may have a particular niche where it is effective.

Questions to Ask Your Doctor

How does plaque develop in the arteries?

Would you recommend atherectomy instead of balloon angioplasty for the condition?

Is atherectomy considered an outpatient procedure or is hospitalization recommended?

What is the recovery time?

Will a lifestyle be necessary after an atherectomy?

Will changing eating habits help prevent additional plaque build-up?

Can plaque build up again? If so, will an atherectomy have to be done again?

Are there any medications that can be taken to alleviate plaque buildup?