An atherectomy is a procedure that mechanically removes plaque and other debris that can block arteries throughout the body.
Atherectomies can be used to widen arteries that have closed or become blocked following a balloon angioplasty or treatment with stents.
Atherectomy treats diseased coronary (heart) arteries, but is used less commonly in arteries outside the heart.
An atherectomy is a procedure used to remove plaque-cholesterol and fibrous tissue that blocks arteries. During an atherectomy, a physician clears a clogged artery by cutting, shaving, or vaporizing the plaque that is blocking a blood vessel. The device used to perform an atherectomy is attached to a thin tube called a catheter.
Today most atherectomy procedures are performed in the coronary (heart) arteries. Far less commonly, physicians perform atherectomy in peripheral arteries (those in other parts of the body such as the legs).
WHEN IS THE PROCEDURE INDICATED?
Atherectomy may be indicated in patients who have coronary artery disease or artery disease in other areas of the body. Factors a physician considers when deciding whether to perform atherectomy include:
The location or shape of plaque deposit;
The size or anatomy of the patient's arteries;
Whether the plaque is exceptionally hard, or calcified; and
Whether clots are present in the artery.
A few days before the procedure, the physician performs blood tests and the patient may be advised to stop taking aspirin or other drugs known to interfere with blood clotting. The physician also orders imaging tests prior to the procedure, such as:
Computerized tomography (CT) scan;
Arteriogram, also known as angiogram; or
Magnetic resonance angiogram (MRA).
Typically, people scheduled for atherectomy should not eat or drink anything for 8 to 12 hours before the test.
WHAT TO EXPECT
The patient is given a mild sedative and any necessary medications. The remains alert during the procedure.
The site where the catheters are inserted (usually above the femoral artery in the groin) is cleaned and shaved and is numbed with a local anesthetic. The physician then makes a tiny incision in the skin and inserts a guide wire and then a catheter sheath over the wire. Catheters may be withdrawn and inserted through the sheath during the procedure.
Based on an arteriogram, the physician chooses the appropriate device to perform the atherectomy. There are two main categories of atherectomy devices-those that shave or cut plaques, and those that pulverize plaques. Once the physician has selected the appropriate device, he or she advances it through the arteries to the plaque.
Atherectomy is usually followed by angioplasty and stenting to widen the artery. The procedure takes approximately 1 to 3 hours.
POST-PROCEDURE GUIDELINES AND CARE
The patient is asked to drink fluids and hospital staff monitors his or her vital signs during recovery. Atherectomy patients usually stay overnight in the hospital following the procedure. After 2 days, most patients can resume normal activities.
Complications that occur at the site of atherectomy depend on the arteries being treated and which device is used and include:
Hematoma (the collection of blood in tissues);
Distal embolization, or pieces of blood clot that break off at the atherectomy site and travel downstream to arteries beyond the atherectomy;
Hemoglobinuria (hemoglobin in the urine);
Dissection, or splitting open a blood vessel;
Abrupt vessel closure; and
Atherectomy does not address the cause of hardening of the arteries. Patients should address risk factors for atherosclerosis by making the following lifestyle changes: