ATHERECTOMY AND ALSO CALLED ATHERCTOMY ATHERECTOMY

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1. ATHERECTOMY PREPARED BY : VANDANA BHATT

2. INTRODUCTION The idea of atherectomy is to reduce the plaque burden without affecting the rest of the vessel wall. Atherectomy technique debulks & remove atherosclerotic plaque by cutting, vaporizing or shaving with catheter deliverable devices. They offer theoretical advantages of eliminating stretch injury, limiting acute dissection (the need for adjunctive stenting) & reducing elastic recoil, thereby potentially reducing the rate of restenosis.

3. What is the principle of rotational atherectomy ? High-speed mechanical rotational atherectomy relies on plaque ablation and pulverization by the abrasive diamond-coated burr. The rotational atherectomy device can ablate inelastic tissue selectively while maintaining the integrity of elastic tissue due to the principle of differential cutting. Differential cutting is ablating one material selectively while saving and preserving the integrity of another. This is based on different substrate composition, resulting in a polished smooth lumen.

4. How it works? The Rotational Atherectomy System console regulates the flow of air to the advancer, controlling burr rotation speed. It also monitors and displays burr rotation speed and rotational atherectomy procedural time. The console may be powered by both nitrogen and compressed air . Speed : B etween 135,000 and 180,000 rpm

5. Elastic tissues   A connective tissue composed of elastic fibers produced by fibroblasts and can stretch up to 1.5 times their length and snap back to their original length when relaxed . such as those of the lungs, skin, and blood vessels, which depend on elasticity for their function.

6. What is plaque? Plaque is the build up in arteries of fat, cholesterol, calcium and other substances. When plaque builds, it can block blood flow, or it can rupture, causing blood clots. This build up of plaque is called  atherosclerosis . An atherectomy is a treatment for atherosclerosis .

7. Types of Atherectomy

8. What are the types of atherectomies ? Directional atherectomy : a minimally invasive procedure to remove blockage from coronary arteries to improve blood flow to the heart muscle and ease pain. Rotational atherectomy : Tiny blades cut plaque in a circular motion. Orbital atherectomy : A spinning tool works like sandpaper to remove plaque.

9. What is the difference between angioplasty and atherectomy ? Angioplasty : A balloon is inflated to push the plaque aside and open your artery. Angioplasty with stent placement (after the balloon, we place a metal frame the holds the artery open) Atherectomy : Shaver or laser cuts the plaque away

10. Who is a candidate for atherectomy ? Atherectomy is most commonly used if you have already had a balloon angioplasty or stent placed, but still have poor blood flow.

11. How Many Procedure Time? An atherectomy procedure usually lasts around two hours. You have anesthesia to keep you comfortable. An interventional cardiologist or vascular surgeon, interventional echocardiographer and an anesthesia specialist work together to perform the procedure.

12. Make and Model in our Hospital Make : Boston scientific Model : RC 5000

13. What are the Complications of Atherectomy? Abrupt vessel occlusion. Dissection Distal emboli Hematoma at access site Infection Pseudoaneurym Renal failure

14. What are the Risk of Atherectomy? Arrhythmias (irregular heart rhythms) Bleeding. Blood vessel damage. Heart attack. Infection.

15. Advantage Minimally invasive procedure Helps restore healthy blood flow and relieves symptoms of peripheral artery disease (PAD).

16. Disadvantage Sometimes a piece of plaque can break off and become lodged or stuck in a smaller downstream blood vessel as healthcare providers cut or scrape away plaque. The atherectomy procedure can also cut too deep and create a tear or hole in your blood vessel . Re-blockage of an artery (typically occurs in smokers) X-ray exposure (which may cause cancer)