What is Atherectomy?
BDS (Bachelor of Dental Surgery), 10 years of experience
What is the meaning of Atherectomy?
The procedure of excision (removal) of an atheroma is known as atherectomy.
An abnormal accumulation of fat, with a fibrous cap on top within the wall of a blood vessel, is known as atheroma.
As the accumulation of fat increases, there is a progressive narrowing of the blood vessel affecting the blood supply to the organ or tissue that it supplies. This leads to a condition known as atherosclerosis. The condition can be life-threatening if it occurs in the coronary arteries (blood vessels supplying the heart). The procedure of atherectomy involves the accumulated plaque (fat, cholesterol, calcium, or cellular waste accumulation) removal in the walls of the blood vessels.
In this article, we will be discussing in detail atherectomy procedures.
- What are the different types of Atherectomy?
- What is the purpose of Atherectomy?
- What is the diagnostic procedure before an Atherectomy?
- How to prepare for an Atherectomy?
- What is the procedure of Atherectomy?
- How to care after an Atherectomy procedure?
- What are the risks of Atherectomy?
- What is the cost of Atherectomy in India?
What are the different types of Atherectomy?
Depending on the kind of device that is attached to the catheter (a thin tube that is inserted in the body to carry out the procedure) for the removal of plaque, the different types of atherectomy include:
Directional atherectomy:
- The plaque is shaved off gently by the cutting tip of the catheter.
- The various pieces of the plaque are collected in a different part of the catheter, and then removed.
- These devices are used for peripheral blood vessels (blood vessels supplying the feet and legs).
Rotational atherectomy:
- A cutting tip spinning at a high speed grinds the plaque into a powder.
- The powder is later washed away in the stream of blood safely.
Orbital atherectomy:
- This procedure involves the use of a high-speed rotational device, similar to rotational atherectomy.
- The tip of the catheter is however modified.
Laser atherectomy:
- The catheter tip has a device emitting a high-energy laser for vaporizing or altering the plaque material. ( Know more about- What are the arrhythmias of the heart ? )
What is the purpose of Atherectomy?
Atherectomy procedure is indicated in the following cases:
- Restoring the blood flow in cases of atherosclerosis
- Before a coronary angioplasty (a procedure of widening the blocked or narrowed coronary arteries), to break the hard and calcified plaque
- Removal of plaque build-up after an angioplasty ( Know more about- What is Coronary Angiography? )
What is the diagnostic procedure before an Atherectomy?
- Blood tests: Blood tests help in checking the levels of the various blood parameters and for the presence of any underlying medical conditions like thyroid disorders or diabetes.
- Urine tests: Urinary infections can be diagnosed with the help of urinalysis.
- Imaging tests: Imaging tests such as x-rays, CT scans, MRI scans, ultrasounds are done to obtain clear pictures of the internal organs of the body.
- Chest and lung x-ray: It helps in assessing the condition of the lungs and heart before the surgery.
- Electrocardiogram (ECG): This test is done to record the electrical activity of the heart and diagnose abnormalities in the heart.
- Echocardiogram: An ultrasound is used to obtain the images of the heart. It helps the doctor in the evaluation of the pumping action of the heart. ( Know more about – What is Echocardiography? )
- Coronary angiogram: The location and extent of the blood vessel blockages can be determined by injecting a contrast dye into the arterial system and coronary vessels and then taking an x-ray. This test is normally advised if there is a suspected coronary artery disease (blockage of the blood vessels supplying the heart muscle).
How to prepare for an Atherectomy?
- Inform your doctor if you are allergic to medications, anesthetic agents, or contrast dyes.
- Inform your doctor if you have any underlying medical conditions.
- Inform your doctor about any medications, herbs, or supplements that you may be taking.
- Quit smoking a couple of weeks before and after the procedure.
- You will need to get admitted to the hospital on the evening before the procedure.
- Do not eat or drink anything eight before the procedure.
- The doctor may give a sedative the night before the procedure to help you relax.
- The skin over the site of the procedure is cleaned, and the hair over it is shaved off.
What is the procedure of Atherectomy?
- The procedure is normally done under local anesthesia (the area of operation is numbed).
- Medications are administered during the procedure to relax the blood vessels, control the blood pressure, and prevent blood clot formation.
- The surgeon makes a small incision or cuts in the thigh region.
- A thin flexible tube, called a catheter, is inserted into the femoral artery that is present in the thigh region.
- Various imaging-tests guidance is used to guide the catheter up. The catheter has a sharp cutting or rotating tip to shave off the plaque accumulation.
- A guidewire is used for guiding the catheter during the procedure.
- The tip is activated and the plaque is removed.
- The catheter may have to be passed several times for removing large amounts of plaque.
- The plaque removal may be followed by balloon angioplasty (a small balloon at the tip of the catheter is inflated to flatten or compress the plaque against the wall of the artery) and insertion of a stent (a small, metal, mesh-like device that may be placed inside a coronary artery to act as a support and keep the blood vessel open, helping in improving the blood flow to the heart).
- A dye contrast is injected inside to check the latency of the arteries, and whether blood flow to the organ had been restored.
- The catheter is removed after completing the procedure and the wound is then covered by a dressing.
- The procedure takes a few hours to complete.
How to care after an Atherectomy procedure?
- Constant pressure is applied over the dressing for a minimum of twenty minutes immediately after the procedure.
- Painkillers are given intravenously (injected directly into the vein) to relieve pain.
- The patient presses on the operative site with his/her fingers if he/she feels the need to cough or sneeze.
- The patient is advised to lie flat on the back and avoid bending knees for approximately six hours after the procedure.
- The patient is generally allowed to go home from the hospital one to two days after the procedure.
- Avoid strenuous activities and heavy lifting for 3 weeks after the procedure.
- Your normal diet can be resumed when your doctor advises you for the same.
- A follow-up appointment with your doctor is advised seven days after the procedure.
What are the risks of Atherectomy?
The complications associated with the atherectomy procedure are:
- Allergic reaction to the contrast dye or anesthetic agent
- Tearing of the blood vessel wall ( Know more about- What is Heart Bypass Surgery? )
- Bleeding
- Chest pain ( Know more about- Home remedies for Chest Pain )
- Heart attack
- Blood clot formation
- Blockage of the blood vessel
- Arrhythmias (disturbances in the heart rhythm)
- Embolization (a dislodged blood clot travels along the blood vessel and blocks another blood vessel)
What is the cost of Atherectomy in India?
The total cost of atherectomy in India can range from around INR 2,60,000 to INR 4,50,000. However, many prominent hospital doctors in India specialize in atherectomy. But the cost varies across different hospitals.
If you are coming from abroad, apart from the cost of atherectomy, there will be an additional cost of living in a hotel and the cost of local travel. After the procedure, the patient is kept for one to two days in the hospital and seven days in the hotel for recovery. So, the total cost of atherectomy in India comes to a total of INR 3,40,000 to INR 5,80,000.
We hope that we could answer all your questions regarding atherectomy through this article.
If you need more information about atherectomy, you can contact a Cardio-Vascular and Thoracic Surgeon.
We only aim to provide you with information through this article. We do not recommend any medication or treatment to anyone. Only a qualified doctor can give you the best advice and correct treatment plan.
