atherectomy


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Related to atherectomy: directional atherectomy

Atherectomy

 

Definition

Atherectomy is a non-surgical procedure to open blocked coronary arteries or vein grafts by using a device on the end of a catheter to cut or shave away atherosclerotic plaque (a deposit of fat and other substances that accumulate in the lining of the artery wall).

Purpose

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.

Precautions

Atherectomy should not be performed when the plaque is located where blood vessels divide into branches, when plaque is angular or inside an angle of a blood vessel, on patients with weak vessel walls, on ulcerated or calcium-hardened lesions, or on blockages through which a guide wire won't pass.

Description

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.

Preparation

The day before atherectomy, the patient takes medication to prevent blood clots and may be asked to bathe and shampoo with an antiseptic skin cleaner.

Aftercare

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.

Risks

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.

Key terms

Atherosclerotic plaque — A deposit of fat and other substances that accumulate in the lining of the artery wall.
Balloon angioplasty — A surgical procedure in which a balloon catheter is used to flatten plaque against an artery wall.
Coronary arteries — The two main arteries that provide blood to the heart. The coronary arteries surround the heart like a crown, coming out of the aorta, arching down over the top of the heart, and dividing into two branches. These are the arteries where coronary artery disease occurs.
Hematoma — A localized collection of blood, usually clotted, due to a break in the wall of blood vessel.

Resources

Books

McPhee, Stephen, et al., editors. Current Medical Diagnosis and Treatment, 1998. 37th ed. Stamford: Appleton & Lange, 1997.

Organizations

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. http://www.americanheart.org.
Texas Heart Institute. Heart Information Service. PO Box 20345, Houston, TX 77225-0345. http://www.tmc.edu/thi.

atherectomy

 [ath″er-ek´tŏ-me]
the removal of atherosclerotic plaque from an artery using a rotary cutter inside a special catheter guided radiographically; it does not extend to the tunica intima as endarterectomy does.

ath·er·ec·to·my

(ath'e-rek'tō-mē),
Any removal by surgery or specialized catheterization of an atheroma in the coronary or any other artery.

atherectomy

(ăth′ə-rĕk′tə-mē)
n. pl. atherecto·mies
Surgical removal of atherosclerotic plaque from an artery using a catheter fitted with a cutting device.

atherectomy

The removal of potentially occlusive atheromatous plaques from the lumen of a major artery (e.g., coronary, carotid or arteries of the limbs) by coronary balloon angioplasty, lasers, drill-tipped catheter or other methods.

atherectomy

The removal of potentially occlusive atheromatous plaques from the lumen of a major artery–eg, coronary, carotid, or arteries of the limbs, by coronary balloon angioplasty, lasers, drill-tipped catheter, or other methods. See Directional coronary atherectomy.

ath·er·ec·to·my

(ath-ĕr-ek'tŏ-mē)
Invasive removal of an atheroma or plaque from an artery.
References in periodicals archive ?
The primary endpoint was freedom from major adverse events occurring within 30 days post-procedure and was compared with an objective performance goal derived from historical atherectomy trials.
FlexTip is a unique new atherectomy guidewire with a nitinol core and shapeable stainless-steel tip for increased flexibility and kink-resistance, improved navigation, and reduced guidewire bias in complex coronary vessels.
Long-term clinical outcome of rotational atherectomy followed by drug-eluting stent implantation in complex calcified coronary lesions.
The COMPLIANCE 360[degrees] Trial: a randomized, prospective, multicenter, pilot study comparing acute and long-term results of orbital atherectomy to balloon angioplasty for calcified femoropopliteal disease.
However, nodular calcification in the SVG is very rare, and PCI for this lesion using rotational atherectomy might be challenging.
The device used for the procedure was the Diamondback 360 Peripheral Orbital Atherectomy System (OAS; Cardiovascular Systems, Inc.).
Inclusion criteria for case group were patients who underwent coronary angiography then candidate for elective CABG and simultaneously had indication for coronary atherectomy who are had significant and long standing coronary stenosis and surgeon could not performed graft anastomosis to formation of an appropriate lumen size.
Goldstein about the cutting-edge techniques and new technologies used to perform atherectomy of the lower extremities.
has received CE Mark approval for Pantheris a system that combines directional atherectomy capabilities with real-time intravascular visualization to remove plaque from blocked arteries.
Results on 10 patients to date, at nine-month follow-up after an angioplasty or atherectomy, showed that those patients who also were infused with dexamethasone to the adventitia of the targeted blood vessel using the Bullfrog Micro-Infusion Catheter have now passed nine months without restenosis of the index lesion.
The fresh capital will be also used in support of Avinger's research and development activities related to its peripheral atherectomy catheter Wolverine.
Subsequently, a therapeutic device such as an angioplasty balloon, stent or atherectomy catheter can be used to restore circulation to the arteries of the leg.