Illustration of three types of atherectomy devices being used to remove plaque in a blood vessel
|ICD-9-CM||39.50, 00.61 -00.62|
Atherectomy is a minimally invasive surgical method of removing, mainly, atherosclerosis from a large blood vessel within the body. Today, it is generally used to effectively treat  peripheral arterial disease of the lower extremities. It has also been used to treat coronary artery disease, albeit ineffectively.
Unlike angioplasty and stents, which push plaque into the vessel wall, atherectomy involves removing the plaque burden within the vessel. Increasing the vessel lumen by removing the plaque burden improves downstream wound healing, reduces claudication and pushes amputation levels more distal. While atherectomy is usually employed to treat arteries it can be used in veins and vein 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 (CFA). However, wire and catheter access can occur from wherever a doctor is willing to stick. Other common places are the brachial artery, radial artery, popliteal artery, dorsalis pedis, and others.
The procedure is considered less invasive than endarterectomy, which involves the surgical cut down and removal of plaque from the inner wall of a diseased vessel.
The advantages of atherectomy when compared to endarterectomy include less procedure time, ease of use, faster patient recovery, decreased systemic complications, repeatability in light of new occlusions. It also serves as a chance for non-surgical candidates.
The advantages of atherectomy when compared to balloons (angioplasty) and stenting are less vessel barotrauma, no foreign object (stent metal) left in the body and leaving all future options open for the patient at the treated site.
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.
- Keeling WB, Shames ML, Stone PA, Armstrong PA, Johnson BL, Back MR, Bandyk DF (January 2007). "Plaque excision with the Silverhawk catheter: Early results in patients with claudication or critical limb ischemia". Journal of Vascular Surgery 45 (1): 25–32.
- Wasiak J, Law J, Watson P, Spinks A (2012 December). "Percutaneous transluminal rotational atherectomy for coronary artery disease". Cochrane Summaries.
- "Use and abuse of atherectomy: where should it be used?". Semin Vasc Surg 21 (4): 204–9. December 2008. doi:10.1053/j.semvascsurg.2008.11.007. PMID 19073311.