Coronary Atherectomy

Patients

Atherectomy is a treatment option for coronary artery disease (CAD) patients whose condition is not successfully treated with medication alone. Developed as a result of advances in medical technology in the last twenty years, atherectomy is less invasive than surgery, and for certain lesions, can be safer than other minimally invasive catheter-based procedures.

For certain lesions, atherectomy puts less strain on the arterial walls than balloon angioplasty, particularly in treating calcified lesions. Atherectomy can be used as a stand-alone treatment or in combination with balloon angioplasty or a stent.

Your physician will determine the best course of action based on the following criteria: the type and location of plaque in your arteries, your specific anatomy, your medical history, and individual needs.

How the Technology Operates

Atherectomy is a catheter-based procedure intended to remove calcified (hardened) plaque that is blocking an artery and blood supply to the heart. There are two different kinds of atherectomy available: rotational atherectomy and directional atherectomy. The Rotablator® System is a rotational atherectomy device.

The Rotablator® System uses a tiny football-shaped tip, also known as a "burr," that is coated with diamond crystals. The tip travels through the artery over a thin guide wire and is driven by an air turbine. As it crosses the blocked or narrowed area, it ablates or sands away the hardened plaque. The microscopic plaque particles move downstream and are naturally removed by the body’s circulatory system.

Directional atherectomy uses a catheter which has a small window on one side, and a balloon on the other. When the balloon inflates, the window presses against the arterial wall and exposes the plaque to a rotating blade. The blade shaves the plaque and stores it in a collection chamber. The plaque is removed when the device is withdrawn.

In either type of atherectomy, it is critical to understand that it is designed not to damage the normal artery wall. The Rotablator® System tip is designed to cut away only inelastic, hard material such as calcified plaque. Normal, healthy tissue is elastic and is deflected out of the way. The mechanism of action is similar to shaving, in which the razor cuts the hard, inelastic whisker, but not the soft, elastic surrounding skin.

The Procedure

Your doctor will instruct you on how to prepare for the procedure prior to being admitted to the hospital. Your doctor may ask you to take aspirin and other prescribed medications for several days before the procedure. This is done to “thin” the blood to prevent blood clots from forming during the procedure. It is important to tell your doctor if you cannot take aspirin or have a history of bleeding problems. Your doctor also needs to know if you are taking any other medications or have drug allergies.

The procedure will be performed under local anesthetic so that you can talk to your physician and respond to instructions. Bring with you to the hospital any hearing aids, dentures, contacts, or eyeglasses that you may need to communicate effectively with the physician.

After the local anesthetic is administered to numb the small incision site in the groin, arm, or wrist, the physician will insert an introducer sheath into a blood vessel in the incision site and then feed the catheters into the blood stream to the affected portion of the coronary artery. Several injections of x-ray dye (called contrast) will be made so that the physician can choose the best "working angle" to view the blocked artery. A guide wire is threaded through the catheter until it extends past the area to be treated. At this point, you may hear the Rotablator® System being tested. It will be inserted through the catheter and over the guide wire toward the blocked area. You will then hear the Rotablator System as it is advanced across the blocked area several times. It is important to note that you will not feel the Rotablator System burr when it spins.

You may feel some discomfort when the sheath is inserted, and may also experience tightness or discomfort in the chest while the catheter is being guided to the lesion. If you feel any pain during the procedure, notify your physician immediately. The entire procedure is likely to be finished in less than two hours. Once the procedure has been completed, the physician will take several "after" pictures. These will be compared to the "before" pictures to help evaluate the success of the procedure.

You will then be transferred to a recovery room where you will be carefully monitored and given any necessary medication. You will probably stay overnight in the hospital. The next day, you should be on your way home and you will probably be able to return to normal daily activities quickly.

Ask your physician for more information about the specific procedure which you will undergo. He or she will tell you how to prepare for it, what to expect, and what your recovery will be like.