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What is it ?
ATHRECTOMY
Atherectomy, as the name suggests, is excision or cutting of the plaque or blockade of the coronary arteries with the help of
a special device which is passed from the groin vessels. The use of stenting and atherectomy
has improved success rates most dramatically in the treatment of more complex lesions. As examples, calcified
lesions respond well to rotational atherectomy, bifurcation lesions to directional atherectomy, and vein grafts to stenting.
- DIRECTIONAL ATHERECTOMY- The directional atherocath is a device with a window in a cylinder that permits a circular cutting blade to excise tissue into a chamber in the catheter which can be removed.
However a study, CAVEAT, has concluded that atherectomy alone in native coronary arteries does not lead to apparent benefit at six months or at one year.
- Adjunctive balloon angioplasty - Current practice when atherectomy is used involves removal of significant tissue followed by balloon PTCA if atherectomy alone does not provide an ideal lumen with zero percent stenosis. The approach of following maximal tissue removal with adjunctive balloon post-dilatation in an effort to reduce the final residual stenosis to <15 percent is referred to as "optimal" atherectomy. The results with this approach are better than with atherectomy alone.
- Use of intracoronary ultrasound - Intracoronary ultrasound (ICUS) is a new technology that allows in-vivo visualization of the coronary artery that has become particularly useful in further delineating plaque morphology and distribution.
- Adjunctive therapy with abciximab - Directional atherectomy is associated with an increase incidence of MI, especially what is known as non-Q wave infarctions. By addition of a blood thinning drug called abciximab the rate of serious complications was significantly reduced.
- ROTATIONAL ATHERECTOMY - Rotational atherectomy is performed with a rapidly rotating olive-shaped ball with diamond chips which grinds calcified atheroma into small particles that can pass harmlessly through the distal myocardial capillary bed. This technique has been most useful for heavily calcified lesions which cannot be easily approached by balloon angioplasty or directional atherectomy. Concurrent use of stents may improve the long-term outcome in such lesions. As is true for directional atherectomy, rotational atherectomy can be followed by balloon PTCA to achieve a better final result.
Use for in-stent restenosis - Although atherectomy has the potential to dislodge or disrupt the stent rotational and directional atherectomy have been used successfully to treat diffuse in-stent restenosis. Rotational atherectomy leads to acute lumen gain as a result of effective removal of plaque while adjunctive PTCA produces additional lumen gain by further stent expansion and tissue extrusion. Prior to performing this procedure, however, some investigators recommend that intravascular ultrasound be obtained to determine whether restenosis is due to stent recoil or a tissue growth. The interest in atherectomy for the treatment of in-stent restenosis, however, has been reduced by the popularity of the "cutting balloon".
Any Interventional procedure would always include a cardiac catheterization. Cardiac catheterization is a test done in the Catheter lab to pinpoint the cardiac problem. Cardiac catheterization is a very safe procedure. Complications are so rare that it may be done on an outpatient basis. As with any medical procedure, though, there are risks.
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