Helen Ng RDSC 326 Professor Gary Zimmerman Atherectomy Helen Ng RDSC 326 Professor Gary Zimmerman

What is atherectomy? Atherectomy is a procedure that mechanically removes plaque from the arterial wall. It can be used to widen arteries that have closed or become blocked following a balloon angioplasty or treatment with sents.

Types of Atherectomy Directional Atherectomy Rotational Atherectomy Transluminal Extraction Atherectomy

Directional Atherectomy Designed to remove non-calcified plaque Catheter tip has hollow end w/rotating blade It has an open window on one side and a balloon on the other. Balloon is inflated, pushing window against plaque. Plaque protruding through window is shaved off by the rotating blade. The shavings are then caught in the chamber and removed

Directional Atherctomy catheter

Directional Athrectomy

Rotational Atherectomy Most common type of atherectomy performed Used for heavily calcifeid plaques and restenosis inside of stents Rotational atherectomy blades are shaped like a football w/diamond coated tip. The blade spins at about 200,000rpm, and grinds away plaque into small fragments The small fragments are then passed harmlessly through our circulatory system

Rotational Atherectomy catheter

Transluminal Extraction Atherectomy Usually used for bypass graft arteries Tiny rotating blade and a hollow tube Particles are sucked into a tube through a vacuum

Preparation prior to procedure Patient cannot eat or drink after midnight Tests completed before admission to hospital EKG Chest x-ray Blood test

Incision Sites Groin/Femoral Artery (most common) Arm/Brachial Incision on the inside of upper thigh Arm/Brachial Incision on the inside of elbow Transradial Incision on inside of wrist

Postoperative Care Patient is returned to recovery room and is monitored Bed rest Sheath is removed with six hours after procedure When patient is discharged from hospital they should monitor the insertion site for bleeding, discoloration, and temperature change Limit physical activity for 2 days Follow up with doctor in 1-2 weeks after discharge Follow up tread mill test performed to determine success of procedure

Effectiveness of Procedure Atherectomy is 95% successful 30% of patients develop restenosis Second atherectomy may be needed

Risk and Benefits Risks Heart attack Emergency bypass surgery Coronary artery perforation Benefits Open blocked arteries Improve blood flow to heart Relieves symptoms Improves exercise duration Stops or prevent heart attacks