Atherectomy Surgery – Definition, Types, Risks & Procedure

With a growing rate of registered heart conditions, atherectomy surgery is one of the most common treatments recommended by doctors. This article highlights all key aspects of atherectomy procedures to create awareness and offer valuable insights about this procedure.

An atherectomy surgery removes plaque from an artery or blood vessel in the heart. In this procedure, the elimination of this plaque formed due to excessive cholesterol, fat, or gunk completely takes place with the help of a catheter. The insertion of this catheter with a sharp blade on end into an artery is a technique used by a doctor to discard the plaque from an artery.

Atherectomy is a procedure which mainly removes atherosclerosis from the blood vessels. A cardiologist or vascular surgeon suggests atherectomy in the following cases:

• To improve the blood flow of peripheral or coronary arteries.
• To break a complex and calcified plaque, atherectomy procedures are opted before coronary angioplasty.
• For removing the accumulation of plaque before an angioplasty treatment.

Generally, atherectomy is performed due to the reasons mentioned above; however, there are various types of this procedure by which the plaque removal takes place. Based on a patient's condition, a doctor chooses the right method of atherectomy.

This section highlights the various types of atherectomy for the patients to understand how the procedures take place. The below mentioned procedures are effective towards curing atherosclerosis and peripheral artery ailments. Cardiologists opt for any of the procedures depending on the health condition of the patient.

1. Directional Atherectomy

In this type of atherectomy, plaque shaving occurs after cutting the tips of a catheter. This removal of this plaque is done into various pieces and in a separate catheter which is then removed. Mostly this type of atherectomy is performed for blockage of peripheral blood vessels. This process has to be done several times to shave the plaque. The devices used in directional atherectomy are used mainly for peripheral blood vessels and not for renal arteries, coronary etc. 

Benefits

• The process restores continuous flow of blood in the native artery by removing plaque.
• This process is ideal for treating eccentric lesions.
• It can be used to cure peripheral lesions in vessels that have a diameter of 1.5- 7.0 mm.

2. Rotational Atherectomy

In rotational atherectomy, a catheter consisting of a spring coil shaft and burr is inserted at the tip. The burr and shaft is then connected to a hand-controlled advancer, which can be moved to cut across the accumulated plaque. The device contains a rotator blade on the top that spins at high speeds that grinds plaque into powder, washing them into the blood . Rotational atherectomy is used particularly for inelastic, heavily calcified coronary lesions. 

Benefits

• It is an effective way to perform atherectomy in coronary vessels which removes atheromatous plaque through a differential cutting method.

3. Orbital Atherectomy

Similar to a rotational atherectomy, this procedure takes place in the same way with a rotator blade attached to the tip of a catheter. As the device, based on an orbiting eccentric crown is placed towards the end of the drive shaft, it results in  rotation, leading to a wider orbital path that facilitates continuous blood flow. In this procedure, a single insertion is required, where the plaque accumulated towards the catheter's nose cone after the crown is moved back and forth within the lesion. 

Benefits

The orbital movement removes the plaque which increases the debuling area along with increasing the crown’s rotational speed

4. Laser Atherectomy

Laser atherectomy is the most prevailing procedure to treat peripheral artery disease (PAD) and is perhaps the most efficient, faster and precise process. In this laser atherectomy, the tip of a catheter constitutes a very powerful laser that evaporates plaque from its core.  A saline fusion is used in this process to safeguard any damage caused to red blood cells.  

Benefits

• In laser atherectomy, excimer laser technology is used to vaporise atheromatous peripheral arterial ailments.
• The catheters that are involved in the process use ultraviolet radiation for the removal of atheroma from arterial lumen.
• The technology used in the method uses low penetration depth and throbbed delivery of high energy. It helps them get the disruption of atheroma, without affecting the surrounding arterial tissue.

There are certain ways in which an individual who will undergo an atherectomy procedure must act. When a CAD is suspected, individuals have to undergo a coronary angiogram, which proceeds when a contrast dye is injected into the patient’s arterial system. It helps doctors locate blockage of the blood vessels and decide on the mode of treatment. Once they opt for atherectomy, patients have to undergo several blood tests, imaging and urine tests.

• Patients must quit smoking or avoid smoking a few weeks before and after the treatment procedure.
• It is important for an individual to inform about their existing medical condition to concerned doctor.
• Any discrepancies in the above-mentioned tests like uncontrolled blood sugar, underlying infections etc. will have to be treated before  commencing with the treatment.
• One must refrain from eating for at least hours before the atherectomy procedure.
• Individuals will be on sedative the night before and the skin on the operative site will have to be cleaned and shaved before treatment.

Though specialist doctors conduct atherectomy procedures with utmost care so that the chances of complications diminish and a patient recovers quickly. However, there are cases where atherectomy procedures instigate certain complications, which are:

• Bleeding
• Acute chest pain
• Reaction to a contrast dye used
• Formation of blood clotting
• Existing or additional blockage in the blood vessels
• Disturbances in the heart rhythm or Arrhythmias

The above mentioned are the possible risks in atherectomy which may occur in very rare cases. However, by following the restrictions as per doctor’s guidelines, one can avoid these complications to a great extent.

A procedure like an atherectomy involves thorough preparation and needs an initiation of proper communication with an operating doctor. Before understanding this procedure of atherectomy and the steps associated with it, here are some prerequisites to follow.

• A patient must let a doctor know about any existing medication allergies or intake of any prescription drugs. Informing doctors about ongoing medical conditions is pivotal.
• If the diet of a patient includes any supplements or herbs, that must be communicated thoroughly.
• It is advisable to stop smoking for a few weeks before or after an atherectomy.
• Based on consultation with a doctor, a patient must be admitted to the hospital an evening before this procedure.
• It is advisable not to consume any drink or whole food at least eight hours before this procedure.
• Preparation of this procedure begins with cleaning and shaving the top layer of skin. Finally, a doctor will give some sedatives to the patient to relax and sleep the night soundly before this surgery. 

Once a patient is ready for an atherectomy procedure, doctors run various important tests to detect the condition of organs before the surgery. Some of the essential tests include:

• Blood and Urine Tests: The blood tests help to derive the content of thyroid or diabetes and various parameters of the blood. On the other hand, a urine test is concerned with the report of urinalysis.
• Coronary Angiogram: This test shows the location of blockages in the blood vessels. This detection helps in injecting a contrast dye into an arterial system.
• Lungs and Chest X-rays: As the name suggests, these help determine a patient's lungs and heart condition before the surgery.
• Echocardiogram and Electrocardiogram (ECG): Echocardiogram determines the image of the heart and helps the doctors to understand any abnormalities in the heart.
• Electrocardiogram (ECG): This test involves an electrical way of detecting heart movement.
• Imaging Tests: This test involves X-rays, CT scans, MRI scans and ultrasounds, which give complete pictures of all internal organs and their conditions.

This procedure of atherectomy involves countless measures that are pivotal to take care of for successful completion of this treatment. Here are the step-by-step procedures of the atherectomy surgery that the specialists: 

Step 1: Doctors perform mild local anaesthesia on the area where it will be operated.

Step 2: Healthcare professionals give medicines to the patients to control the blood pressure and calm the blood vessels to restrict any blood clotting.

Step 3: An operating surgeon performs a small incision in a patient’s thigh part.

Step 4: In this inserted part, a specialist passes a thin tube or catheter to a femoral artery. Before performing this step, imaging tests and other X-rays help doctors to locate an exact spot.

Step 5: The blade attached to the tip of a catheter carefully shaves the plaque accumulation. Based on the density of this plaque accumulation, a doctor may pass a catheter multiple times for complete removal.

Step 6: If a doctor finds it necessary, an atherectomy will be followed by the traditional angioplasty.

Step 7: Finally, a doctor checks the blood pressure and removes a catheter for a complete check-up. After this, a healthcare professional stitches the wound with proper dressing to avoid any further infections.

If a doctor finds any complications, he/she may ask the patient to stay under medical guidance for supervision. Though this procedure offers astonishing results, however; doctors do not recommend the same to all patients. People with Type-II and Type-III diabetes will require additional attention to conduct atherectomy surgery.

After the completion of the surgery, healthcare specialists continuously apply pressure for a time span of more than twenty minutes on a spot of a wound. If necessary, patients have suggested some painkillers to impart relief from the pain. In addition to this, doctors ensure that patients do not catch any cold to avoid sneezing or coughing.

Moreover, a doctor strictly forbids bending knees at least six hours after the procedure. If a post-surgery report is clear, then a hospital discharges a patient within one or two days of this procedure. For a speedy recovery and to avoid any future complications, it is advisable to steer clear of lifting heavy weights for a minimum of 3 weeks after this surgery.

Patients undergoing atherectomy surgery need to follow an appropriate diet and opt for follow-up appointments with a concerning doctor. By maintaining a balanced lifestyle, any future complications can be avoided.

On observing the following symptoms, one must communicate their issues with the doctor.  Firstly the symptoms might go unnoticed, however as the coronary arteries narrows down with time, the flow of blood to the heart gets disrupted leading to the following symptoms.

• Chest pain
• Shortness of breath
• Fatigue
• Heart attack

The most effective alternative to Atherectomy surgery is angioplasty and stenting. There are different devices that are placed on the site of blockage. Angioplasty is a standard treatment to ensure the proper functioning of the arteries around the heart by opening the narrowed or blocked artery.

Angioplasty is mainly of two types:

Balloon angioplasty: In this doctors use the pressure of an inflated balloon to remove the plaque, thereby opening the blocked artery. The balloon is basically a designed catheter that is placed within the corridor towards the blockage. However, doctors opt for balloon angioplasty only if they cannot place a stent in the site where the artery is blocked.

Stent placement: A mesh frame called stent is placed inside the vessels to prevent the artery from narrowing after the procedure. Stents that are coated with medicine, known as drug eluting stents to prevent scar tissue from growing inside the stent.

Patients suffering from complications of atherosclerosis experience great relief after the completion of surgery. One of the primary benefits of atherectomy surgery is that this procedure is ideal where removal of blockages cannot be done using a stent. In other words, this treatment does not require the use of any foreign element like a stent to remove plaque from the arteries.

With growing advancements in medical and surgical procedures, treating these ailments has become comparatively easier. However, by following a balanced lifestyle and aligning with great habits, one can keep these ailments at bay.