Atherectomy

Why is the doctor performing this procedure?

To remove plaque build-up (atherosclerosis) that is narrowing or blocking one of the coronary (heart) arteries.

What is the procedure?

"Ather" refers to an atherosclerotic plaque within a heart artery; "ectomy" means to cut it out. Atherectomy is often part of a PTCA (angioplasty) procedure, but instead of compressing the plaque into the artery wall, as is done with balloon angioplasty, atherectomy actually cuts away and removes fatty plaque to widen the artery and improve blood flow. A catheter is inserted into an artery—usually in the groin—but sometimes in the arm or wrist. The catheter is advanced to the heart, and a series of x-ray pictures (coronary angiogram) are taken to clearly visualize the heart artery that is narrowed. Then a separate catheter with a cutting device is advanced to the heart, and into the narrowed coronary artery. Inside the artery, the cutting device cuts away at the plaque, widening the artery so blood flow improves.

There are three different devices commonly used to perform atherectomy:

• Directional Coronary Atherectomy (DCA) uses a very small rotating blade within a balloon to cut out the plaque and remove it safely from the blood vessel.

• Rotational Atherectomy uses a diamond-studded, acorn-shaped drill to grind plaque down and is especially useful for calcified plaques.

• Extraction Atherectomy uses several tiny rotating blades within a hollow tube to cut away the plaque, then uses vacuum suction thru the tube to remove the pieces from the vessel.

Balloon angioplasty and/or stent placement usually follows atherectomy.

Where is the procedure performed?

In the Cardiac Catheterization Lab.

How long does this procedure take?

Atherectomy usually takes 1-3 hours.