Atherectomy is a medical procedure designed to address blockages within arteries. This minimally invasive intervention specifically focuses on the mechanical removal of plaque, a buildup of fatty substances, cholesterol, calcium, and other materials that can accumulate on arterial walls. By clearing these obstructions, atherectomy aims to widen the affected artery and restore proper blood flow.
Understanding Atherectomy
Atherectomy involves the physical removal of atherosclerotic plaque from the inner lining of an artery. Unlike angioplasty, which uses a balloon to compress plaque against the arterial wall, atherectomy actively extracts or pulverizes the obstructive material. Similarly, while stenting places a mesh tube to prop an artery open, atherectomy’s primary goal is to eliminate the plaque itself. In many cases, atherectomy may precede or be combined with angioplasty and stenting to optimize outcomes, particularly when dealing with stubborn or calcified blockages.
Conditions Treated by Atherectomy
Peripheral Artery Disease (PAD) and Coronary Artery Disease (CAD)
Atherectomy serves as a treatment option for various conditions characterized by arterial plaque buildup, primarily peripheral artery disease (PAD) and certain instances of coronary artery disease (CAD). PAD involves narrowed arteries outside of the heart and brain, commonly affecting the legs, leading to symptoms like pain, numbness, or non-healing wounds. CAD refers to blockages in the arteries supplying the heart muscle, which can cause chest pain or shortness of breath.
When Atherectomy is Considered
This procedure is often considered when the plaque is particularly hard, calcified, or difficult to treat with other methods like balloon angioplasty alone. Atherectomy can effectively modify or remove stiff, calcified plaques, making subsequent treatments more successful. It can also be beneficial for patients who have not responded well to prior interventional procedures.
How Atherectomy is Performed
The atherectomy procedure typically begins with local anesthesia at the access site, often in the groin or wrist, and sometimes mild sedation. A small incision is made, and a thin, flexible catheter is inserted into an artery. This catheter is guided through the blood vessels to the plaque buildup, often with X-ray imaging and a contrast dye.
Once the catheter reaches the blockage, a specialized device at its tip is activated to remove the plaque. Different atherectomy devices employ various mechanisms, such as tiny rotating blades, high-speed burrs, or lasers. The removed plaque particles are either collected within the device or become small enough to be safely cleared by the bloodstream. The procedure usually lasts about one to two hours, depending on the complexity of the blockage.
What to Expect After Atherectomy
Following an atherectomy, patients typically spend a period of recovery under observation. Most individuals can return home the same day or within 24 hours, as it is generally an outpatient procedure. Mild discomfort, bruising, or soreness at the access site is common and can be managed with pain medication. Patients are usually able to resume light activities within a few days, though strenuous activity might be restricted for a couple of weeks.
While atherectomy is minimally invasive, potential risks exist, including bleeding, infection, or damage to the artery such as a tear or dissection. There is also a small chance that a piece of plaque could break off and travel to another vessel, or that the treated artery could narrow again over time. Medical staff will monitor for these complications and provide specific care instructions for optimal recovery.