Atherectomy for coronary artery disease

Treatment Overview

Atherectomy involves techniques similar to those used for angioplasty. The difference is that atherectomy uses a cutting device (a blade, or a whirling blade called a rotoblade, and occasionally a laser beam) to remove the plaque buildup from the artery wall. See an illustration of types of atherectomy of a coronary artery.

What To Expect After Treatment

After an atherectomy, you will be moved to a recovery room or to the coronary care unit. Your heart rate, pulse, and blood pressure will be closely monitored, and the catheter insertion site will be checked for bleeding. To prevent bleeding, you will have a large bandage or a compression device on your groin at the catheter insertion site. You will be instructed to keep your leg straight if the insertion site is in your groin area.

You most likely will start walking within 12 to 24 hours after an atherectomy. The average hospital stay is 1 to 2 days for uncomplicated procedures. After several days, you may resume exercise and driving.

You will most likely be given aspirin after atherectomy to help prevent the formation of blood clots.

Why It Is Done

Atherectomy is a procedure used to open up narrowed coronary arteries to increase blood flow. Atherectomy can open up an artery that has hard plaque and that might not open up with angioplasty alone.

How Well It Works

Studies have shown that atherectomy can be as effective as angioplasty. Early studies found greater complication rates with atherectomy than with angioplasty. However, using better techniques and stents, success rates appear to be similar for both procedures, especially when stenting is also used.1, 2 This is because once atherectomy is done, inserting the balloon and stent is much easier. However, using atherectomy may increase the length of the procedure, and it may be associated with more chest pain (angina) and a slow heart rate during the procedure.

Risks

Risks of atherectomy may include:

  • Heart attack during the procedure (small percentage).
  • Closing off of the artery, which requires emergency bypass surgery.
  • Bleeding.
  • Heart rhythm problems.

Another risk is that small pieces of plaque that are cut off during atherectomy can lodge in smaller arteries and damage heart tissue. But the latest devices used for atherectomy can filter or capture these small pieces and remove them from the blood.

The risk for complications during atherectomy can be reduced if it is performed by a cardiologist who is experienced with the procedure.

What To Think About

The best use of atherectomy in treating coronary artery disease remains to be determined. Issues that need to be resolved include:

  • Choosing who is most likely to benefit. Certain situations, such as uneven plaque buildup or veins that have renarrowed after use in bypass surgery, may be best treated using atherectomy.
  • Whether removing more fat and calcium buildup from the artery leads to better or worse long-term results. It can be difficult to insert and place a stent in an artery when the narrowed artery is heavily calcified. For good results in stent placement, atherectomy may be done first. However, the risks of the combined atherectomy and stent placement may be greater than standard angioplasty. Talk with your doctor about this risk and whether bypass surgery might be a better option.

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References

Citations

  1. Baim DS, et al. (1998). Final results of the balloon vs. optimal atherectomy trial (BOAT). Circulation, 97(4): 322–331.
  2. Simonton CA, et al. (1998). Optimal directional coronary atherectomy: Final results of the optimal atherectomy restenosis study (OARS). Circulation, 97(4): 332–339.

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