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Atherectomy Helen Ng RDSC 326 Professor Gary Zimmerman.

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1 Atherectomy Helen Ng RDSC 326 Professor Gary Zimmerman

2 What is atherectomy? Atherectomy is a procedure that mechanically removes plaque from the arterial wall. Atherectomy is a procedure that mechanically removes plaque from the arterial wall. It can be used to widen arteries that have closed or become blocked following a balloon angioplasty or treatment with sents. It can be used to widen arteries that have closed or become blocked following a balloon angioplasty or treatment with sents.

3 Types of Atherectomy Directional Atherectomy Directional Atherectomy Rotational Atherectomy Rotational Atherectomy Transluminal Extraction Atherectomy Transluminal Extraction Atherectomy

4 Directional Atherectomy –Designed to remove non-calcified plaque –Catheter tip has hollow end w/rotating blade –It has an open window on one side and a balloon on the other. –Balloon is inflated, pushing window against plaque. –Plaque protruding through window is shaved off by the rotating blade. The shavings are then caught in the chamber and removed

5 Directional Atherctomy catheter

6 Directional Athrectomy

7 Most common type of atherectomy performed Most common type of atherectomy performed Used for heavily calcifeid plaques and restenosis inside of stents Used for heavily calcifeid plaques and restenosis inside of stents Rotational atherectomy blades are shaped like a football w/diamond coated tip. The blade spins at about 200,000rpm, and grinds away plaque into small fragments Rotational atherectomy blades are shaped like a football w/diamond coated tip. The blade spins at about 200,000rpm, and grinds away plaque into small fragments The small fragments are then passed harmlessly through our circulatory system The small fragments are then passed harmlessly through our circulatory system Rotational Atherectomy

8 Rotational Atherectomy catheter

9 Transluminal Extraction Atherectomy Usually used for bypass graft arteries Usually used for bypass graft arteries Tiny rotating blade and a hollow tube Tiny rotating blade and a hollow tube Particles are sucked into a tube through a vacuum Particles are sucked into a tube through a vacuum

10 Preparation prior to procedure Patient cannot eat or drink after midnight Patient cannot eat or drink after midnight Tests completed before admission to hospital Tests completed before admission to hospital –EKG –Chest x-ray –Blood test

11 Incision Sites Groin/Femoral Artery (most common) Groin/Femoral Artery (most common) –Incision on the inside of upper thigh Arm/Brachial Arm/Brachial –Incision on the inside of elbow Transradial Transradial –Incision on inside of wrist

12 Postoperative Care Patient is returned to recovery room and is monitored Patient is returned to recovery room and is monitored Bed rest Bed rest Sheath is removed with six hours after procedure Sheath is removed with six hours after procedure When patient is discharged from hospital they should monitor the insertion site for bleeding, discoloration, and temperature change When patient is discharged from hospital they should monitor the insertion site for bleeding, discoloration, and temperature change Limit physical activity for 2 days Limit physical activity for 2 days Follow up with doctor in 1-2 weeks after discharge Follow up with doctor in 1-2 weeks after discharge Follow up tread mill test performed to determine success of procedure Follow up tread mill test performed to determine success of procedure

13 Effectiveness of Procedure Atherectomy is 95% successful Atherectomy is 95% successful 30% of patients develop restenosis 30% of patients develop restenosis –Second atherectomy may be needed

14 Risk and Benefits Risks Risks –Heart attack –Emergency bypass surgery –Coronary artery perforation Benefits Benefits –Open blocked arteries –Improve blood flow to heart –Relieves symptoms –Improves exercise duration –Stops or prevent heart attacks


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