How is it done?
Atherectomy is preceded by Cardiac catheterization. Cardiac catheterization is performed by a specially trained team of technicians, nurses, and doctors. A long, thin, flexible tube, a catheter, is inserted into a blood vessel in the arm or leg. A special type of x-ray screen, called a fluoroscope, shows the blood vessels and the heart so the doctor can guide the catheter into the correct position.

Heart pressures are measured inside the heart chambers. Samples of blood are taken through the catheter. Other tests depend on your particular problems.

X-ray studies are usually made during cardiac catheterization. Dye is injected through the catheter into different areas of the heart. One type, the coronary angiogram, shows blood flow through the coronary arteries to locate blockages. A ventriculogram shows the size and pumping action of the heart muscle, as well as the opening and closing of the heart valves. The electrical conduction system can also be tested to pinpoint the cause of irregular heartbeats and test how well the drugs are working to correct them.

If the procedure is done in a hospital, you will usually be admitted a day before the procedure. If you are allergic to shellfish or have ever had a reaction to x-ray dye, be sure to tell your doctor. The area where the catheter is inserted, usually the arm or the groin area, is shaved. You are not allowed to have anything to eat or drink 6 to 12 hours before the procedure.

Most people are a little nervous to learn that they will be awake during the procedure to follow the doctor's instructions. However, you should experience little discomfort. You are given a sedative before the procedure to help you relax. You will be monitored throughout the procedure.

Some procedure rooms may use tables that move from side to side while the x-rays are taken. In other rooms the table remains in one position while the camera moves around you. In either case, you are securely strapped to the table.

The area where the catheter is inserted is shaved and disinfected, and your arm or leg is strapped down. Sterile towels are placed over you to prevent infection. You usually cannot see what is occurring. After a local numbing medicine is injected, a small incision is made for the insertion of the catheter.

As the catheter is inserted, you will feel a slight pressure. At times during the procedure, the doctor may ask you to hold your breath, cough, and breathe deeply. You may also be asked to breathe oxygen. Medications may also be given during cardiac catheterization. Nitroglycerin is sometimes used to dilate the coronary arteries. If you heart's electrical conduction system is tested, you may be given drugs to speed up or slow down your beat.

Cardiac catheterization takes between 1 and 4 hours, depending on how many tests are performed.

When the x-ray dye is injected, you may experience a flushing sensation and nausea, but this will disappear quickly.

Atherectomy
Atherectomy may be done to improve blood flow to your heart. During this procedure, a catheter with a special grinding device is used. This device clears away the plaque in your blocked artery. After cardiac catheterization is done, a catheter called a guiding catheter is put into the blocked artery. A guide wire is then put through the guiding catheter. This wire is moved to the narrowed spot in your artery. The doctor watches the wire on the video screen. A special atherectomy catheter is threaded over the guide wire. The catheter is moved to the narrowed part of your artery.

The atherectomy catheter has a coarse burr near its tip. The doctor uses this burr to grind the plaque into very small bits. These bits float away in the bloodstream.

After the atherectomy, the doctor may do a balloon angioplasty. Angioplasty will compress any remaining plaque against the artery wall. Also, a stent may be placed. The catheters and guide wire are then removed. With the plaque reduced, blood flow to the heart muscle increases.

A stent is a small metal coil or mesh tube. After balloon angioplasty or atherectomy, a stent may be placed in the artery. This helps prevent the artery from narrowing again. The stent is mounted on a balloon-tipped catheter. The stent catheter is threaded over the guide wire. The catheter is moved to the part of the artery that was treated with balloon angioplasty or atherectomy. The balloon is inflated to open the stent. This also helps to further compress the plaque. When the stent is fully open, all catheters and the guide wire are removed. The stent stays in place. It helps prevent the artery from narrowing again (restenosis).

Your doctor may prescribe a 'blood thinning'(antiplatelet) medication for 2 to 4 weeks after the stent is in place. The medication helps prevent blood clots from forming on the stent. Your doctor may also suggest that you take aspirin life long to help prevent blood clots.