Atherectomy is a catheter-based procedure to remove plaque from the artery arteries. A catheter is introduced into an artery in the leg and guided into the coronary artery. On the tip of the catheter is either a high-speed rotating device ("burr"), or a sharp blade. The burr grinds the plaque into minute particles, while the blade shaves the plaque away. Following this
procedure, a balloon angioplasty or stent may also be performed. An atherectomy is useful in cases where the plaque is very hard due to calcification, plaque has built up in a coronary artery bypass graft, or to remove of other difficult blockages.
Coronary atherectomy removes plaque from the arteries supplying blood to the heart muscle. It uses a laser catheter, or a rotating shaver ("burr" device on the end of a catheter). The catheter is inserted into the body and advanced through an artery to the area of narrowing. Other devices are dissectional catheterectomy, catheters that shave off the plaque, or laser catheters that vaporize the plaque. Balloon angioplasty or stenting may be used after an atherectomy.
Persons with plaque buildups in the carotid arteries or major arteries of the neck are at higher risk for stroke. Carotid endarterectomy is an effective surgical procedure that can help them. It removes the plaque to reduce the risk of stroke.
Atherectomy is performed to restore the flow of oxygen-rich blood to the heart, to relieve chest pain, and to prevent heart attacks. It may be done on patients with chest pain who have not responded to other medical therapy and on certain of those who are candidates for balloon angioplasty (a surgical procedure in which a balloon catheter is used to flatten plaque against an artery wall) or coronary artery bypass graft surgery. It is sometimes performed to remove plaque that has built up after a coronary artery bypass graft surgery.
Atherectomy uses a rotating shaver or other device placed on the end of a catheter to slice away or destroy plaque. At the beginning of the procedure, medications to control blood pressure, dilate the coronary arteries, and prevent blood clots are administered. The patient is awake but sedated. The catheter is inserted into an artery in the groin, leg, or arm, and threaded through the blood vessels into the blocked coronary artery. The cutting head is positioned against the plaque and activated, and the plaque is ground up or suctioned out.
The types of atherectomy are rotational, directional, and transluminal extraction. Rotational atherectomy uses a high speed rotating shaver to grind up plaque. Directional atherectomy was the first type approved, but is no longer commonly used; it scrapes plaque into an opening in one side of the catheter. Transluminal extraction coronary atherectomy uses a device that cuts plaque off vessel walls and vacuums it into a bottle. It is used to clear bypass grafts.
Performed in a cardiac catheterization lab, atherectomy is also called removal of plaque from the coronary arteries. It can be used instead of, or along with, balloon angioplasty. Atherectomy is successful about 95% of the time. Plaque forms again in 20-30% of patients.
After the procedure, the patient spends several days in the hospital's cardiac monitoring area. For at least 20 minutes, pressure is applied to a dressing on the insertion site. For the first hour, an electrocardiogram and close monitoring are conducted; vital signs are checked every 15 minutes. Pain medication is then administered. The puncture site is checked once an hour or more. For most of the first 24 hours, the patient remains in bed.
Chest pain is the most common complication of atherectomy. Other common complications are injury to the blood vessel lining, plaque that re-forms, blood clots (hematoma), and bleeding at the site of insertion. More serious but less frequent complications are blood vessel holes, blood vessel wall tears, or reduced blood flow to the heart.