Atherectomy

What is atherectomy?

An atherectomy is a procedure to remove plaque from an artery. Plaque is a buildup of fats and cholesterol that blocks blood flow through an artery. This buildup is also called an atheroma. Atherectomy uses a shaver to cut the atheroma away and remove it.

When is it used?

This procedure is most often used to open coronary arteries that are partly blocked. The coronary arteries are the blood vessels that carry oxygen and nutrients to the heart. Directional coronary atherectomy is one of the ways to open a blocked coronary artery without opening the chest. This procedure takes out most of the blockage in the artery and allows more blood flow to the heart muscle.

Examples of alternatives to this surgery are:

• balloon angioplasty, which uses a catheter and balloon to stretch and unblock the artery
• balloon angioplasty with a stent, which is a tiny metal device placed inside an artery to hold the artery open and unblock it
• coronary bypass surgery, which is an operation that opens the chest and uses arteries from the chest, or veins from the legs or arms, to make a path around blocked areas in the heart.

How do I prepare for the procedure?

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow the instructions your healthcare provider gives you. Eat a light meal the night before the procedure. You may be asked not to eat or drink anything for 12 hours before the procedure.

What happens during the procedure?

You will be given medicine to help you relax and a local anesthetic to numb the place where the catheter will be inserted. You will stay awake during the procedure. The atherectomy catheter, which is a small tube with a balloon on the end, is put into an artery in your groin.

Using X-rays, the tip of the catheter is guided to the atheroma. The balloon is blown up, which brings part of the atheroma close to an opening near the tip of the catheter. A tool in the catheter is used to shave small parts of the atheroma from the blockage. The bits of shaved atheroma are stored in the tip of the catheter and the catheter is taken out.

Sometimes you may feel chest discomfort during the procedure, but there is usually very little pain.

What happens after the procedure?

You must stay in the hospital for a short time after the procedure. If there are no problems, you can go home within a day or two.

For a week after the procedure, don't do any heavy lifting or hard physical exercise. Then you can go back to normal activity.

You will take aspirin to reduce the chances of the artery becoming blocked again.

What are the benefits of this procedure?

Atherectomy opens blocked heart arteries without major surgery. The procedure sometimes opens an artery better than balloon angioplasty.

What are the risks of this procedure?

• You may have an allergic reaction to the local anesthetic or X-ray dye.
• You may bleed a lot and need medicine or a blood transfusion.
• The artery may be damaged. For example, the catheter might poke a hole in the artery during the procedure. Emergency surgery or repair of the hole would then be needed.
• There is a risk of injury to the groin or arm where the catheter was inserted.
• The blockage may come back after 3 to 6 months.
• The procedure could cause a heart attack or stroke.

There is risk with every treatment or procedure. Talk to your provider for complete information about how the risks apply to you.

When should I call my healthcare provider?

Call your provider right away if:

• You have chest pain.
• You have constant or worsening pain or numbness in your arm or leg.
• You have a fever.
• You have shortness of breath.
• Your arm or leg becomes blue and cold.
• You have bleeding, excess bruising, or a lot of swelling where the catheter was inserted.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.