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Coronary Atherectomy (Rotational & Laser)

Coronary Atherectomy is a minimally invasive procedure to remove the blockage from the coronary arteries and allow more blood to flow to the heart muscle and ease the pain caused by blockages.  The types of atherectomy are rotational and transluminal extraction (laser). 
 
Rotational atherectomy uses a high speed rotating shaver to grind up plaque.  Transluminal extraction coronary atherectomy uses a device that cuts plaque off vessel walls and vacuums it into a bottle.  It is often used to clear bypass grafts.

Performed in a cardiac catheterization lab, atherectomy is also called removal of plaque from the coronary arteries.  It can be used instead of, or along with, balloon angioplasty. Atherectomy is successful about 95% of the time.  Plaque forms again in 20-30% of patients.

The procedure begins with the physician injecting some local anesthesia into the groin area and putting a needle into the femoral artery, the blood vessel that runs down the leg.  A guide wire is placed through the needle and the needle is removed.  An introducer is then placed over the guide wire, after which the wire is removed.  A different sized guide wire is put in its place.

Next, a long narrow tube called a diagnostic catheter is advanced through the introducer over the guide wire, into the blood vessel.  This catheter is then guided to the aorta and the guide wire is removed.  Once the catheter is placed in the opening or ostium of one the coronary arteries, the physician injects dye and takes an x-ray.

If a treatable blockage is noted, the first catheter is exchanged for a guiding catheter. Once the guiding catheter is in place, a guide wire is advanced across the blockage, then a catheter designed for lesion cutting is advanced across the blockage site.  A low-pressure balloon, which is attached to the catheter adjacent to the cutter, is inflated to expose the lesion matter to the cutter.

The cutter breaks the blockage up into microscopic pieces. These tiny pieces are stored in a section of the catheter called a nosecone, and removed after the intervention is complete. Together with rotation of the catheter, the balloon can be deflated and re-inflated to cut the blockage in any direction, allowing for uniform debulking.

A device called a stent may be placed within the coronary artery to keep the vessel open. After the intervention is completed the physician injects contrast media and takes an x-ray to check for any change in the arteries. Following this, the catheter is removed and the procedure is completed.

In addition to regular checkups, your physician usually schedules some tests, including an exercise stress test, within the first six months after your athrectomy. These test check to see whether your artery has remained open.

During the first six months after your athrectomy, your treated artery may narrow again. Tell your physician if you feel symptoms like the ones you had before your athrectomy. Your physician may recommend further testing or other procedure to treat the problem.

Angioplasty can help in the treatment of coronary artery disease, but it is not a true cure. You need to change any unhealthy habits (also called risk factors) that helped create your heart problems in the first place. Some risk factors are smoking, eating too much fat and salt and not getting enough exercise. Making changes to reduce risk factors can help keep your heart condition form getting worse and may even improve the health of your heart.  If you have any questions or concerns, please call your physician.

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