Atherectomy

What is atherectomy?

An atherectomy is a procedure to remove plaque from an artery. Plaque is a buildup of fats and cholesterol, called an atheroma, that partly or completely blocks blood flow through an artery.

Removing an atheroma used to require opening the chest and the artery. Now, however, a device can be inserted in a groin artery which can then be directed to atheromas in the heart arteries or in blood vessels in the legs or neck. This process is called directional atherectomy. It is most commonly used in the coronary arteries in the heart.

Since the U.S. Food and Drug Administration (FDA) approved the first atherectomy device for use in 1990, the agency has approved two others. They are also inserted through a groin artery. One, named the Rotablator, is tipped with a diamond-studded burr that rotates at high speed. It operates much like the plumber's Roto-Rooter and grinds the atheroma into very small pieces that are carried away by the bloodstream. The second device has a cutting head that rotates at the tip of the tube. The small pieces of the atheroma are removed by suction. All of these procedures produce about the same results.

When is it used?

People who benefit from this procedure are those whose coronary arteries are partly or completely blocked. These people might otherwise have coronary bypass surgery or balloon coronary angioplasty. For some blockages, however, balloon angioplasty does not work well. In these cases, directional coronary atherectomy offers a way to open the blocked artery without opening the chest. It is especially effective in people who have odd-shaped blockages of their arteries.

You and your doctor will decide whether to use the atherectomy technique after discussing the benefits and risk. Your doctor will base his or her recommendation on the location and characteristics of the atheroma.

How do I prepare for the procedure?

Do not have anything to eat or drink, even water, after midnight on the day before the procedure.

What happens during the procedure?

You will be given a shot to numb the area in your groin, but you will remain awake. A small balloon-tipped tube, the atherectomy catheter, is inserted into an artery in your groin.

Using a x-rays that allow the doctor to see motion, the tube is guided to a precise position. The balloon is inflated, which forces a portion of the atheroma into an opening near the tip of the tube. Small parts of the atheroma are shaved from the blockage and removed from the tube when it is withdrawn.

This procedure enlarges the artery and allows more normal blood flow to the heart muscle. Sometimes you may feel chest distress during the procedure, but there is usually very little pain.

What happens after the procedure?

You must stay in the hospital for a short time after the procedure. If no problems occur, you can go home within a day or two.

For a week after the procedure, don't do any heavy lifting or hard physical exercise. Then you can resume normal activity.

You will take aspirin to reduce the chances of the artery becoming blocked again. Your doctor may also prescribe Warfarin, a blood thinner taken by mouth, for you to take for a few weeks after the procedure.

What are the risks?

Major problems, including heart attack, the need for emergency bypass surgery, and death, occur in about 6% of such procedures. You may bleed from the site where the tube was inserted. Nearly 30% of the arteries opened by atherectomy become blocked again within the first 6 months after the procedure. This is also true for balloon coronary angioplasty.

What are the benefits?

Atherectomy opens blocked heart arteries without opening the chest. The procedure sometimes opens an artery better than balloon angioplasty.

When should I call the doctor?

Call your doctor if:

you develop any chest pain

you get severe pain in you leg where the tube was placed

you notice bleeding from the puncture site

you notice increased swelling or tenderness in the puncture area