Atherectomy is a specialized, minimally invasive medical procedure designed to address blockages within the body’s arteries. This intervention utilizes a catheter-based system to physically remove or reduce the atherosclerotic plaque buildup that restricts blood flow. By clearing these obstructions, the procedure serves the broad goal of restoring healthy circulation to vital organs and extremities.
What Atherectomy Treats
The primary condition necessitating atherectomy is atherosclerosis, a progressive disease characterized by the accumulation of a fatty substance known as plaque on the inner walls of arteries. Plaque is a complex mixture of cholesterol, fats, cellular waste products, and calcium, which hardens over time, causing the arteries to narrow and stiffen. This process, often referred to as “hardening of the arteries,” starves downstream tissues of necessary oxygen and nutrients.
Atherectomy is frequently used to manage Peripheral Artery Disease (PAD), where blockages occur in the non-coronary arteries, typically those supplying the legs and feet. Symptoms of PAD often include claudication, which is muscle pain in the legs triggered by exercise and relieved by rest, as well as non-healing wounds or sores on the lower limbs. These blockages, particularly when heavily calcified, can be highly resistant to other forms of treatment.
In the vessels supplying the heart, the procedure treats blockages associated with Coronary Artery Disease (CAD). While angioplasty and stenting are common treatments for CAD, atherectomy is often chosen when the plaque has become densely calcified, making it difficult to compress or modify with a balloon alone. The mechanical removal of this hardened material helps prepare the vessel wall, allowing for a more successful subsequent stent placement. The selection of atherectomy over other methods is largely determined by the location, length, and particularly the degree of calcification present in the arterial lesion.
The Tools Used in Plaque Removal
The atherectomy procedure begins with the insertion of a specialized catheter into an artery, usually through a small puncture site in the groin, wrist, or arm. Using fluoroscopic imaging, the physician carefully guides the catheter through the vascular system until its tip reaches the precise location of the hardened plaque blockage. Once positioned, the device at the end of the catheter is activated to mechanically remove the obstructive material.
Rotational Atherectomy
The rotational atherectomy device features a tiny, high-speed burr coated with microscopic diamond particles. This burr rotates extremely fast, often exceeding 100,000 revolutions per minute, to ablate or pulverize the calcified plaque. The action of the diamond-tipped crown shaves the hard plaque into minute particles, typically smaller than red blood cells, which are then safely carried away by the bloodstream and filtered out by the body’s reticuloendothelial system. This method is particularly effective for very hard, calcified lesions that might damage other devices.
Directional Atherectomy
Another technique is directional atherectomy, which uses a rotating cutting blade housed within a small, protective nose cone on the side of the catheter. The device is positioned against the plaque, and the blade shaves off the material, collecting the excised pieces into a chamber at the tip of the catheter. The catheter containing the collected plaque is then carefully withdrawn from the body. This mechanism is beneficial for lesions where the plaque is localized to one side of the vessel wall.
Orbital Atherectomy
The orbital atherectomy system employs a rapidly spinning, eccentric crown that rotates and oscillates as it advances through the blocked artery. The oscillation creates a sanding or grinding effect against the plaque, widening the vessel lumen by polishing the surface of the artery wall. This action modifies the consistency of the hard plaque, making it more compliant and amenable to balloon angioplasty or stenting that may follow the procedure.
Post-Procedure Care and Expectations
Following an atherectomy procedure, patients typically spend a short period recovering in the hospital, often being discharged the same day or the following morning. The immediate post-procedure focus is on monitoring the access site where the catheter was inserted to ensure proper clotting and prevent bleeding complications. Patients are generally required to remain lying flat for several hours after the catheter is removed to maintain pressure on the puncture site.
For the first few days at home, specific limitations on physical activity are necessary to allow the puncture site to heal fully. Patients are usually advised to avoid any strenuous exercise, heavy lifting, or activities that involve significant bending or straining for about a week. This precaution minimizes the risk of bleeding or forming a hematoma at the access point.
It is important to watch the insertion site for any signs of infection, such as increased warmth, redness, or discharge, and to report these to the medical team. The physician will also provide instructions regarding the continuation of medications, which frequently includes antiplatelet agents or blood thinners to minimize the risk of new clot formation. Adherence to prescribed medication and attending all scheduled follow-up appointments are necessary steps to ensure the long-term success of the procedure and maintain healthy blood flow.