Atherectomy: Minimally Invasive Coronary Solutions

November 26, 2024

What is Atherectomy?

Atherectomy is a minimally invasive procedure healthcare providers use to remove plaque buildup and open narrow or blocked arteries. The procedure helps restore healthy blood flow and relieves symptoms of peripheral artery disease (PAD). During an atherectomy, the surgeon removes plaque accumulated inside an artery. Plaque is a buildup of fatty deposits, calcium, and other materials on the inner surface of arteries. This accumulation can restrict arteries, reduce blood flow, and potentially cause significant health issues like cardiac arrest, brain hemorrhage, or arterial disease. Any artery in the body can develop this buildup, although the coronary arteries and the legs tend to be the most affected (peripheral arteries).¹
A doctor or cardiovascular surgeon performs an atherectomy, which is a minimally invasive medical procedure, in a hospital setting. The process involves using a catheter with a revolving blade or laser to remove plaque buildup from a damaged artery, improve blood flow, reduce symptoms, and lower the risk of serious complications such as heart attack or stroke. Atherectomy is typically considered when other treatments, such as drugs or catheterization, have failed to remove the blockage.²
However, it’s important to note that not all individuals are suitable candidates for atherectomy. The decision to undergo the procedure depends on various factors, such as the location and severity of the blockage, the patient’s overall health, and the potential risks and benefits of the procedure. While atherectomy can be an effective alternative to open surgery, it’s essential to discuss the options with a healthcare provider and understand the potential implications of the procedure before making a decision.

Atherectomy Devices

Atherectomy treatments employ several device types, each with a unique mechanism of action. Here are a few typical atherectomy tools:

Directional atherectomy devices
Laser atherectomy devices
Orbital atherectomy devices
Rotational atherectomy devices
Directional excisional atherectomy devices³

The Ideal Candidate for Atherectomy

Depending on the specifics of each case, the optimal candidate for an atherectomy treatment may vary, but the following traits are present:

Substantial Plaque Buildup

Doctors often recommend atherectomy to people with significant plaque buildup in their arteries and experiencing symptoms like shortness of breath or chest pain.

Atherosclerosis

Physicians may suggest this technique for individuals with atherosclerosis having narrowed or clogged arteries restricting blood flow.

Failed Alternative Treatments

Doctors may explore atherectomy if alternative treatments, including medication, lifestyle modifications, or other procedures like angioplasty, have failed to alleviate symptoms.

Good Overall Condition

A candidate for an atherectomy should be in good general health and not have any serious illnesses that could raise the risk of complications.

No Risk of Bleeding

Due to the increased risk of bleeding during or after the procedure, people with bleeding problems or those taking blood-thinning drugs may not be ideal candidates for atherectomy.⁴

Methods For Doing Atherectomy

The doctor’s training level, placement, and intensity of the procedure influence the type of atherectomy medical procedure used. To get the best results, doctors may perform a variety of methods. There are several methods for doing an atherectomy, including:

Directional

In this method, a catheter with a sharp cutting blade is inserted into the artery. The blade shaves off plaque from the artery walls, which is collected in the catheter for removal. This technique is particularly useful for localized blockages.

Laser

Doctors introduce a catheter with a laser at its end into the artery and direct it to the site of the plaque to perform a laser atherectomy. The laser vaporizes the plaque, which is then expelled from the body.

Rotational

In rotational atherectomy, a high-speed spinning burr coated with microscopic diamond particles is introduced into the artery via a catheter. The burr rotates at extremely high speeds, grinding the calcified plaque into microscopic particles, which are small enough to be safely transported away by the bloodstream. This technique is particularly effective for treating hardened or calcified plaques that are resistant to other treatments like angioplasty.⁵

Orbital

During an orbital atherectomy, doctors rotate a tiny, diamond-coated burr unconventionally (irregularly) around the plaque. This motion allows the burr to lightly sand and dislodge the plaque without endangering the artery wall.

Transluminal Extraction Catheter (TEC)

In this procedure, doctors use a catheter equipped with a balloon at its tip. The balloon is inflated within the artery at the site of plaque buildup, and a vacuum is created, which helps to draw the plaque into the catheter. The plaque is then removed from the artery, improving blood flow. This technique is used to clear blockages in the arteries, particularly when other methods like rotational atherectomy may not be suitable.

Directional Excisional

Doctors use a catheter with a sharp edge at the tip in the directional excisional atherectomy operation to carefully remove plaque from the arterial walls. The blade is made to solely cut through the plaque, leaving the vital arterial tissue unharmed.⁶

Atherectomy Procedure

The type of atherectomy performed during the procedure and the sequence of steps involved may vary based on the patient’s health and the physician’s training and expertise. The broad overview of what to anticipate during an atherectomy surgery is as follows:

Preparation

Before the medical procedure, your doctor may suggest specific preparatory measures, including fasting for a predetermined period, discontinuing certain medications, and completing a consent document. Furthermore, sedation or anesthesia will be administered to ensure patient relaxation and to facilitate a painless process.

Accessing the Artery

Following a small incision in the skin, the physician will insert a catheter into the artery to access it. X-ray imaging will guide the catheter’s precise placement at the site of the blockage.

Atherectomy – Plaque Removal

After inserting the catheter, the physician will remove the plaque from the artery walls using a particular type of atherectomy apparatus, such as a revolving blade, laser, or burr.

Completing the Procedure

Once the physician removes the plaque, they will remove the catheter and apply pressure to the operative site to stop bleeding. In certain situations, the physician may implant a stent to keep the artery open and improve blood flow.

Recovery

After the treatment, the medical staff will transfer you to a recovery room to monitor you closely for any potential complications. You may need to stay in the hospital briefly before being discharged. Your physician will provide detailed instructions on how to take care of yourself at home, which may involve staying away from physically demanding activities, taking medicine, and making follow-up consultations.⁷

Aftercare of Atherectomy

It’s crucial to look after oneself after an atherectomy treatment to encourage recovery and avoid complications. Here are some general recommendations for aftercare:

Listen to the Doctor’s Advice

Your doctor will give you detailed instructions on how to care for yourself after the treatment, so pay attention to them.

Stay Away from Demanding Activities

After the surgery, you might need to rest for a day or two. For at least a week, stay away from demanding activities. Your doctor could advise you to take some time off of work so that your body can heal.

Report Infections to the Doctor

Look for any symptoms associated with infection, such as inflammation, puffiness, warmth, or discharge at the incision site. If you notice any such symptoms, report them immediately to your doctor.

Maintain Cleanliness

For at least 24 hours following the surgery, it is important to maintain cleanliness and dryness at the incision site. For a few days, your doctor could advise against bathing or showering.

Use the Medication as Directed

After the procedure, you can feel some discomfort or agony. Your doctor may recommend painkillers to help you manage this. Use them as directed.

Follow-up

Your doctor will probably want to see you for follow-up sessions to track your progress and look for issues. Be careful to show up on time for these appointments.

Maintain Healthy Lifestyle

It is crucial to maintain a healthy lifestyle after treatment to avoid further issues. This entails maintaining a nutritious diet, exercising regularly, and quitting smoking.

Atherectomy Vs. Angioplasty

Angioplasty and atherectomy are minimally invasive procedures used to treat blocked or narrowed arteries but differ in their approach. Angioplasty involves inflating a small balloon within the artery to compress the plaque against the walls, often followed by placing a stent to keep the artery open. It is commonly used for moderate blockages and offers a quick recovery.
Atherectomy, on the other hand, removes plaque directly using a catheter with specialized tools such as rotating blades or lasers, making it ideal for severe or calcified blockages. While angioplasty is simpler and widely used, atherectomy is reserved for complex cases and offers more effective treatment for hardened or irregular plaques. The choice between the two depends on the blockage’s severity, type, and location.⁸

Wrap-up

Atherectomy is a minimally invasive and effective option for treating arterial blockages, offering advantages such as shorter recovery times and precision in plaque removal. While generally considered safe, the procedure carries risks like bleeding and tissue injury, which can vary based on the physician’s expertise and the complexity of the case. Atherectomy is particularly beneficial for patients who are unsuitable candidates for other treatments, such as angioplasty or bypass surgery. A thorough discussion with a healthcare provider about the potential risks and benefits is essential before undergoing the procedure.

Refrences

1
Wardle BG, Ambler GK, Radwan RW, Hinchliffe RJ, Twine CP. Atherectomy for peripheral arterial disease. Cochrane Database Syst Rev. 2020 Sep 29;9(9):CD006680. doi: 10.1002/14651858.CD006680.pub3. PMID: 32990327; PMCID: PMC8513671.
2
Chowdhury, M., & Secemsky, E. A. (2022). Atherectomy vs Other Modalities for Treatment During Peripheral Vascular Intervention. Current cardiology reports, 24(7), 869–877. https://doi.org/10.1007/s11886-022-01709-1
3
Sharma, S. K., Tomey, M. I., Teirstein, P. S., Kini, A. S., Reitman, A. B., Lee, A. C., Généreux, P., Chambers, J. W., Grines, C. L., Himmelstein, S. I., Thompson, C. A., Meredith, I. T., Bhave, A., & Moses, J. W. (2019). North American Expert Review of Rotational Atherectomy. Circulation. Cardiovascular interventions, 12(5), e007448. https://doi.org/10.1161/CIRCINTERVENTIONS.118.007448
4
Chowdhury, M., & Secemsky, E. A. (2022). Atherectomy vs Other Modalities for Treatment During Peripheral Vascular Intervention. Current cardiology reports, 24(7), 869–877. https://doi.org/10.1007/s11886-022-01709-1
5
Dill T, Hamm CW. Rotablation: Technik, Indikation, Ergebnisse [Rotational atherectomy: technique, indications, results]. Herz. 1997 Dec;22(6):291-8. German. Doi: 10.1007/BF03044279. PMID: 9483434.
6
Suzuki, S., Okamura, A., Nagai, H., Iwakura, K., Shiojima, I., & Fujii, K. (2022). Tip detection method adapted for identifying plaque localization during directional coronary atherectomy procedure. Cardiovascular intervention and therapeutics, 37(1), 209–210. https://doi.org/10.1007/s12928-020-00726-7
7
Tanaka, K., Koyama, Y., Iwakura, K., Suzuki, S., Nagai, H., & Okamura, A. (2022). Accurate directional coronary atherectomy procedure using the tip detection method and intelligent 3D wiring pro software. Cardiovascular intervention and therapeutics, 37(3), 572–573. https://doi.org/10.1007/s12928-021-00830-2
8
Bai H, Fereydooni A, Zhuo H, Zhang Y, Tonnessen BH, Guzman RJ, Ochoa Chaar CI. Comparison of Atherectomy to Balloon Angioplasty and Stenting for Isolated Femoropopliteal Revascularization. Ann Vasc Surg. 2020 Nov;69:261-273. doi: 10.1016/j.avsg.2020.05.019. Epub 2020 Jun 6. PMID: 32512112.

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