Atherectomy
What Is Atherectomy?
Directional coronary atherectomy (DCA) is a technique by which a catheter with a small mechanically-driven cutter shaves the plaque and stores it in a collection chamber. The plaque is then removed from the artery when the device is withdrawn.
Mechanical rotational atherectomy is a technique that uses a diamond-shaped burr that rotates and shaves the plaque into tiny particles, which then pass through the circulatory system.
What Can I Do to Prepare for My Atherectomy Procedure?
You will probably be asked not to eat or drink anything after midnight on the night before your procedure. If you have not already stopped smoking, your doctor may recommend that you do so prior to being admitted to the hospital in preparation for the upcoming procedure.
Some hospitals do not allow patients to wear dentures or glasses during the procedure. If you have dentures or glasses and want to wear them, ask your nurse about hospital policy.
What Happens Before the Procedure?
Diagnostic Tests
Upon admission to the hospital, your preparation prior to treatment will include tests such as an ECG, a chest x-ray, and routine blood tests.
Talking With Your Doctor
Your doctor will visit you in your hospital room to discuss the procedure in detail and tell you the approximate time the procedure is scheduled. He or she will explain the possible risks and benefits and answer any questions you or your family may have.
Be sure to tell your doctor what medications you are currently taking. You should also tell your doctor about any allergies you have, especially to x-ray dye or iodine. These allergies may require additional medication prior to a procedure. It is also important to let your doctor know if you cannot take aspirin, since this and other medications are usually begun prior to a procedure and continued for several months thereafter.
Ensuring Your Comfort
Just before you leave your room, empty your bladder so you will be comfortable during the procedure. At this time, your nurse will give you some medication to help you relax.
The following two preparatory steps are typically done at this time, but may sometimes be done after you are brought to the catheterization laboratory:
- An intravenous (IV) needle and tube will be placed in the vein in your hand or arm before the procedure. Fluids or medications can be given quickly and easily through this tube if they are needed.
- Your nurse will make marks on your hands and feet where your pulse can be felt. These marks make it easier to check your circulation during and after the procedure.
Where Will the Procedure Be Performed?
Your procedure will be performed in a catheterization laboratory or a special procedure radiology suite. This room may be similar to the one where you had your diagnostic angiogram. You will lie on an x-ray table, and an x-ray camera will move over your chest during the procedure. The staff will monitor your heart by attaching several small, sticky patches to your chest and use a specialized ECG recorder and monitor.
Preparation in the Catheterization Laboratory
Preparing Your Skin
The area where the catheters are to be inserted, either your groin, arm or wrist, will be shaved and scrubbed with antiseptic solution to prevent infection. You will then be covered with sterile sheets.
Before starting the procedure your doctor will inject a local anesthetic (numbing medicine) where the catheters will be inserted. You may feel a stinging sensation as he or she does this. However, after the medication takes effect, you should only feel dull pressure where the physician is working with the catheters. If you do feel pain, please tell your doctor.
Inserting the Guiding Catheter
Your doctor will choose to insert your guiding catheter in one of three spots:
Groin/Femoral Approach
Catheter introduction into the groin requires a small incision to be made on
the inside of your upper thigh so an introducer sheath (short tube) can be
inserted into your femoral artery. Next, your doctor will insert a guiding
catheter (long, flexible tube) into the introducer sheath and advance it
through the aorta to where the coronary arteries branch off to the heart or
affected peripheral artery.
Arm/Brachial Approach
Catheter introduction into the arm requires that a small incision be made on
the inside of your elbow after local anesthesia has been given. The guiding
catheter is then inserted directly into the artery through the small incision
and advanced to where the coronary arteries branch off to the heart or the
affected peripheral artery.
Transradial Approach
Catheter introduction into the wrist requires that a small incision be made on
the inside of your wrist after local anesthesia has been given. The guiding
catheter is then inserted directly into the artery through the small incision
and advanced to where the coronary arteries branch off to the heart or affected
peripheral artery.
Injecting the Dye
After the catheters are inserted, your doctor will inject x-ray dye through the guiding catheter into your artery to look at the narrowing. Your doctor will watch this injection on an x-ray monitor, much like a TV screen. You may be able to watch these pictures yourself. While these x-rays are being taken, your doctor may ask you to take a deep breath and hold it for a few seconds. You may also be asked to cough after the x-ray picture is completed to help speed the removal of the x-ray dye from the arteries.
What Happens During the Procedure?
You will be awake during your procedure. From time to time, your doctor or a staff member may give you instructions. It is important to listen for these instructions and to do what is asked.
Directional coronary atherectomy (DCA) is a technique that allows the selective cutting and retrieval of atherosclerotic lesions (plaque) from coronary arteries. The removal of this tissue is commonly referred to as debulking.
The directional coronary atherectomy device is a catheter with a small mechanically driven cutter that shaves the plaque and stores it in a collection chamber. The plaque is then removed from the artery when the device is withdrawn.
The atherectomy procedure includes five main steps:
The cutter is positioned in the direction of the plaque. This directional control is of particular benefit when there is disease in only some portion of the vessel.
A balloon on one side of the catheter tip is inflated, causing the plaque on the opposite wall of the artery to protrude into the window of the cutting device.
The rotating cutter shaves off this portion of the plaque, which is then stored in the collection chamber of the catheter.
If there is additional plaque, the cutter can be repositioned and the same process applied.
Once sufficient debulking has been accomplished, your doctor may decide to perform angioplasty or other adjunctive therapies following the DCA procedure.
What Happens Right After the Procedure?
Monitoring
After the procedure, you will return to your hospital room where you will be watched closely by the nursing staff. Your blood pressure will be checked frequently, and you will be attached to an ECG monitor so that your heart can be monitored continuously. While you are in bed, a nurse will check the site where the catheter was inserted as well as the pulse in your feet and arms.
Bed Rest
If the Catheter Was Inserted in Your Groin
If your groin was used for the procedure, you can expect to stay in bed for
several hours. The introducer sheath is usually removed within six hours of the
procedure, but may be left in longer if heparin, a medication given during your
procedure, is continued. While the introducer sheath is in place, and for about
six hours after its removal, you will lie flat on your back in bed, keeping
your leg with the sheath straight and still. To remove the introducer sheath, a
nurse or doctor will put pressure on the puncture site for 20 to 30 minutes, or
until there is no bleeding. A sandbag may be placed over the puncture to keep
pressure on it. Although bleeding will be unlikely at this time, if you feel a
warm, wet sensation or sharp pain in the area of the puncture, call a nurse at
once. Stay lying down in bed and press on the puncture with your fingers. The
nurse will show you how to do this. If you happen to cough or sneeze, you
should press on the site with your fingers.
Do not try to sit up until your nurse or doctor instructs you to do so. It is important to lie flat and keep still to prevent bleeding from your artery.
If the Catheter Was Inserted in Your Arm
If your arm was used for the procedure, you may be allowed to sit up
afterwards, but you may be asked to stay in bed for several hours.
Relieving Pain and Discomfort
You will urinate often because your kidneys will be getting rid of the x-ray dye that was injected into your arteries. You will also be asked to drink extra fluids so that your kidneys can get rid of this dye more easily. If you need help with any activity during this time (for example, in using the bedpan or bathroom), ask a nurse to help you.
If you get back pain from lying still, your nurse can make you more comfortable. You may be allowed to bend the leg that was not used for the procedure. Your nurse may also be able to elevate the head of your bed slightly to help relieve back pain. If you are still uncomfortable, your nurse can give you medication for pain.
Mild chest discomfort is common immediately following a coronary procedure but should fade within one or two hours. If your chest pain increases or returns, be sure to notify a nurse right away. If tests suggest that the pain may indicate a problem with the dilated artery, it may be necessary to take additional x-ray pictures of the artery before you go home. A return of chest pain is unusual beyond the first thirty minutes after the procedure.
Going Home
You will be asked to walk within 12-24 hours. The nurse will assist you the first time you get out of the bed.
Before leaving the hospital, you may want to discuss your risk factors for coronary artery and/or peripheral vascular disease with your doctor or nurse. It is important to set realistic goals when planning changes in your lifestyle and eating habits.
After the procedure a patient is usually sent home from the hospital in one to two days. You should arrange to have someone take you home rather than driving yourself.
NOTE: The information provided here is not intended to be used for medical diagnosis or treatment or as a substitute for professional medical advice. Individual symptoms, situations, and circumstances may vary. Please consult your physician or qualified health care provider regarding your condition and appropriate medical treatment.
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