Coronary Atherectomy

Directional coronary atherectomy is a catheter intervention that allows us to shave out specific types of narrowing in the coronary artery. This procedure may be preferable to balloon angioplasty.

Some of the factors that determine angioplasty versus atherectomy are the location of the blockage, the shape of the blockage, the size of the artery and whether clots are present in the artery. All of these considerations are up to the discretion of the interventional cardiologist.

When it is determined that directional coronary atherectomy is appropriate, the pre-existing catheter in the femoral artery needs to be exchanged for a larger catheter. This is due to the greater bulkiness of the directional coronary atherectomy device. A guiding catheter which allows us to place the guide wire and the directional coronary atherectomy device across the lesion is placed in the aorta at the opening of the coronary artery. Once this guiding catheter is in place, an appropriately sized atherectomy device is chosen. Often, if the narrowing is extremely tight, it may need to be predilated with a small angioplasty balloon in order to allow easier passage of the atherectomy device across the narrowing. After this, the atherectomy device is then placed across the narrowing.

The atherectomy device is a large balloon catheter. However, the balloon is only wrapped around a portion of the circumference of the device. It allows for placement of a window in the metal housing on the side of the catheter and this window is then pushed against the plaque by the balloon and a cutting piston is then advanced through the device in order to shave off the plaque tissue that has been placed in the window. This plaque tissue is then pushed into the nose cone of the device and it will be removed later during the procedure. Typically, during this procedure, your doctor will take four cuts at a time before removing the device from the coronary artery and examining the result. On occasion, your doctor will have to again place the device across the narrowing and take multiple cuts. Your doctor may take anywhere from four to more than twenty cuts in a given blockage in order to obtain a good angiographic result. The amount of tissue removed at the end of the procedure can be variable and is dependent upon the amount of plaque present at the site of the narrowing. At the end of the procedure, occasionally a balloon may need to be placed in order to smooth out the angiographic result, although this occurs less frequently. You are then sent back to your room where a period of bedrest is required. The sheath will be removed from your groin after the specific amount of time the cardiologist orders

Source: AdvocateHealth