Atherectomy is a minimally invasive technique for removing atherosclerosis from blood vessels within the body. It is an alternative to angioplasty for the treatment of peripheral artery disease, but the studies that exist are not adequate to determine whether it is superior to angioplasty. It has also been used to treat

coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the heart muscle due to build-up of atherosclerotic pla ...

, albeit without evidence of superiority to angioplasty.

Uses

Atherectomy is used to treat narrowing in arteries caused by peripheral artery disease and

Controversy

The use of atherectomy instead of or in addition to angioplasty remains an area of controversy, as atherectomy typically involves the use of more costly disposable devices, and clear evidence to justify its use is lacking. Atherectomy has high physician reimbursement relative to angioplasty alone.

Technique

Unlike angioplasty and stents, which push plaque into the vessel wall, atherectomy cuts plaque from the wall of the artery. While atherectomy is usually employed to treat arteries it can be used in veins and vascular bypass grafts as well. Atherectomy falls under the general category of percutaneous revascularization, which implies re-canalizing blocked vasculature via a needle puncture in the skin. The most common access point is near the groin through the

common femoral artery The femoral artery is a large artery in the thigh and the main arterial supply to the thigh and leg. The femoral artery gives off the deep femoral artery or profunda femoris artery and descends along the anteromedial part of the thigh in the ...

(CFA). Other common places are the

brachial artery The brachial artery is the major blood vessel of the (upper) arm. It is the continuation of the axillary artery beyond the lower margin of teres major muscle. It continues down the ventral surface of the arm until it reaches the cubital fossa ...

, radial artery, popliteal artery, dorsalis pedis, and others. There are four types of atherectomy devices: orbital, rotational, laser, and directional. The decision to use which type of device is made by the interventionist, based on a number of factors. They include the type of lesion being treated, the physician's experience with each device, and interpretation of the devices' risks and effectiveness, based on a review of the medical literature. Directional atherectomy is an intravascular procedure guided by optical coherence tomography termed as ''lumivascular atherectomy''.

References

{{Vascular procedures Vascular surgery Interventional radiology

Uses

Controversy

Technique

See also

References