Atherectomy

Atherectomy is the removal or excision of an atheroma. An atheroma is the abnormal accumulation of fat with a fibrous cap on top within a blood vessel wall. As the fat accumulation increases, the blood vessel narrows progressively. This affects the blood supply to the tissue or organ that it supplies. This results in a condition known as atherosclerosis. If this condition occurs in blood vessels like the coronary arteries (the blood vessels that supply the heart), it can be life-threatening.

The atherectomy procedure involves the removal of the accumulated plaque gently using a specially tipped instrument that is attached to a catheter. Plaque formation can occur due to the accumulation of fat, cholesterol, calcium, cellular waste, and fibrin (a material that is involved in the clotting of blood) in the blood vessel walls. A catheter is a thin tube that can be inserted into the body for the treatment of certain diseases or performing a surgical procedure. The catheter is introduced into a peripheral artery (arteries in the arms, legs, hands, and feet) like the femoral artery, and then advanced into the affected blood vessel.

Types:
The different types of atherectomy depending on the type of device that is attached to the catheter for the removal of plaque include:

  1. Directional atherectomy: The catheter has a cutting tip used to shave the plaque off gently. The plaque pieces are collected in a different part of the catheter and removed. These devices can only be used for peripheral blood vessels.
  2. Laser atherectomy: The tip of the catheter is provided with a device that emits a high-energy laser for altering or vaporizing the plaque material.
  3. Rotational atherectomy: The catheter has a cutting tip that spins at a high speed to grind the plaque into a powder. This powder is then washed away in the bloodstream safely.
  4. Orbital atherectomy: This is the latest technique in which a high-speed rotational device, similar to a rotational atherectomy, is used but with a modified tip.
Know More About Surgery

Atherosclerosis can affect coronary arteries, carotid arteries and peripheral arteries. Depending on the location of the blockage, the following symptoms may be seen:-

  • Coronary arteries- are those that provide blood to the heart. Symptoms like chest pain, weakness, coughing, dizziness, palpitations and anxiety can indicate a blockage in the coronary arteries.
  • Carotid arteries- carotid arteries supply blood to the brain and a blockage can cause a stroke. Other symptoms may include headaches, facial numbness, troubles with speech, paralysis, loss of balance, problems with coordination, confusion and dizziness.
  • Peripheral arteries- are arteries that supply blood to the limbs. Some of the symptoms include weakness and numbness in the legs, hair loss on legs, erectile dysfunction in men, slower hair and toenail growth on the legs and painful cramps.
  1. Blood tests: A blood test is recommended to assess the overall health status of the patient and check for any underlying medical conditions.
  2. Urine tests: Urine tests help in checking for any underlying urinary infections.
  3. Imaging tests: Various imaging tests like CT scans, MRI scans, ultrasounds may be recommended to obtain clear images of the internal organs of the body.
  4. Coronary angiogram: A contrast dye is injected into the arterial system and the coronary vessels, and then visualized on an x-ray for the determination of the location and extent of the blood vessel blockages. This test is usually performed in the case of suspected coronary artery disease (blockage of the blood vessels that supply the heart muscle).
  5. Electrocardiogram (ECG): It is a test performed to record the electrical activity of the heart and detect any abnormalities in the heart.
  6. Echocardiogram: High-frequency sound waves (ultrasound) are used to obtain images of the heart. This helps the doctor in evaluating the pumping action of the heart.
  7. Chest and lung x-ray: These can be done to assess the condition of the lungs and heart before the surgery.

 

  1. The patient is shifted to the operation table after being wheeled into the operation theatre.
  2. The procedure is normally performed under local anesthesia (the surgical area is numbed) and a mild sedative (a medication used to help you relax) may be administered intravenously (injected into the vein).
  3. Medications are administered during the surgery for relaxing the blood vessels, controlling the blood pressure, and preventing the formation of clots.
  4. A thin flexible tube, known as a catheter is inserted into the femoral artery present in the thigh region by making a small cut (incision) in that area. 
  5. The catheter is then guided up using the various imaging-tests guidance.
  6. A guidewire is used to guide the catheter with a rotating or sharp cutting tip across the block and maneuvered in a manner such that the plaque gets exposed to the cutter.
  7. The tip is then activated and the plaque is removed.
  8. It may be required to pass the catheter several times for the removal of large amounts of plaque.
  9. The removal of plaque may be followed by balloon angioplasty and insertion of a stent.
  10. In the case of balloon angioplasty, a catheter with a small balloon on its tip is used. The balloon is inflated at the site of blockage to compress or flatten the plaque against the wall of the artery.
  11. A stent is a mesh-like, small device that is made of metal. It may be placed inside a coronary artery to act as a support and keep the blood vessel open, thus improving the blood flow to the heart muscle.
  12. A dye contrast is then injected inside to check the latency of the arteries and whether the blood flow to the organ is restored.
  13. After the procedure is complete, the catheter is removed and the wound covered with a dressing.
  14. The procedure takes a couple of hours to complete.

The risks associated with the atherectomy procedure are:

  • Tearing and injury of the blood vessel wall
  • Bleeding around the heart
  • Chest pain
  • Heart attack
  • Embolization (the dislodged clot travels along the blood vessel to block another blood vessel)
  • Arrhythmias (disturbances in the rhythm of the heart)
  • A complete blockage of the blood vessel that may require an emergency bypass
  • Allergic reaction to the anesthesia or contrast dye used during the procedure

 

  1. Pressure is applied over the dressing for minimum of 20 minutes immediately after the procedure.
  2. The patient is then shifted to the recovery room, where he/she will stay for a couple of hours. The patient’s blood pressure and ECG are monitored initially every 15 minutes.
  3. Painkillers are given intravenously to relieve pain and discomfort.
  4. The patient is instructed to press on the operative site with his fingers if the patient feels the need to sneeze or cough. 
  5. The patient is advised to lie flat on his back and avoid bending the knees for approximately six hours after the procedure.
  6. The patient needs to stay in the hospital for one or two days after the procedure until the patient is stable.
  7. Avoid heavy lifting and strenuous activities for 2 to 3 weeks after the procedure.
  8. The medications that were taken previously and normal diet can be resumed when the doctor advices you for the same.
  9. A follow-up visit to the doctor is recommended seven to ten days after discharge from the hospital.

 

Atherectomy Cost in New Delhi

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Atherectomy

Atherectomy is the removal or excision of an atheroma. An atheroma is the abnormal accumulation of fat with a fibrous cap on top within a blood vessel wall. As the fat accumulation increases, the blood vessel narrows progressively. This affects the blood supply to the tissue or organ that it supplies. This results in a condition known as atherosclerosis. If this condition occurs in blood vessels like the coronary arteries (the blood vessels that supply the heart), it can be life-threatening.

The atherectomy procedure involves the removal of the accumulated plaque gently using a specially tipped instrument that is attached to a catheter. Plaque formation can occur due to the accumulation of fat, cholesterol, calcium, cellular waste, and fibrin (a material that is involved in the clotting of blood) in the blood vessel walls. A catheter is a thin tube that can be inserted into the body for the treatment of certain diseases or performing a surgical procedure. The catheter is introduced into a peripheral artery (arteries in the arms, legs, hands, and feet) like the femoral artery, and then advanced into the affected blood vessel.

Types:
The different types of atherectomy depending on the type of device that is attached to the catheter for the removal of plaque include:

  1. Directional atherectomy: The catheter has a cutting tip used to shave the plaque off gently. The plaque pieces are collected in a different part of the catheter and removed. These devices can only be used for peripheral blood vessels.
  2. Laser atherectomy: The tip of the catheter is provided with a device that emits a high-energy laser for altering or vaporizing the plaque material.
  3. Rotational atherectomy: The catheter has a cutting tip that spins at a high speed to grind the plaque into a powder. This powder is then washed away in the bloodstream safely.
  4. Orbital atherectomy: This is the latest technique in which a high-speed rotational device, similar to a rotational atherectomy, is used but with a modified tip.

Symptoms

Atherosclerosis can affect coronary arteries, carotid arteries and peripheral arteries. Depending on the location of the blockage, the following symptoms may be seen:-

  • Coronary arteries- are those that provide blood to the heart. Symptoms like chest pain, weakness, coughing, dizziness, palpitations and anxiety can indicate a blockage in the coronary arteries.
  • Carotid arteries- carotid arteries supply blood to the brain and a blockage can cause a stroke. Other symptoms may include headaches, facial numbness, troubles with speech, paralysis, loss of balance, problems with coordination, confusion and dizziness.
  • Peripheral arteries- are arteries that supply blood to the limbs. Some of the symptoms include weakness and numbness in the legs, hair loss on legs, erectile dysfunction in men, slower hair and toenail growth on the legs and painful cramps.

Diagnosis

  1. Blood tests: A blood test is recommended to assess the overall health status of the patient and check for any underlying medical conditions.
  2. Urine tests: Urine tests help in checking for any underlying urinary infections.
  3. Imaging tests: Various imaging tests like CT scans, MRI scans, ultrasounds may be recommended to obtain clear images of the internal organs of the body.
  4. Coronary angiogram: A contrast dye is injected into the arterial system and the coronary vessels, and then visualized on an x-ray for the determination of the location and extent of the blood vessel blockages. This test is usually performed in the case of suspected coronary artery disease (blockage of the blood vessels that supply the heart muscle).
  5. Electrocardiogram (ECG): It is a test performed to record the electrical activity of the heart and detect any abnormalities in the heart.
  6. Echocardiogram: High-frequency sound waves (ultrasound) are used to obtain images of the heart. This helps the doctor in evaluating the pumping action of the heart.
  7. Chest and lung x-ray: These can be done to assess the condition of the lungs and heart before the surgery.

 

Treatment

  1. The patient is shifted to the operation table after being wheeled into the operation theatre.
  2. The procedure is normally performed under local anesthesia (the surgical area is numbed) and a mild sedative (a medication used to help you relax) may be administered intravenously (injected into the vein).
  3. Medications are administered during the surgery for relaxing the blood vessels, controlling the blood pressure, and preventing the formation of clots.
  4. A thin flexible tube, known as a catheter is inserted into the femoral artery present in the thigh region by making a small cut (incision) in that area. 
  5. The catheter is then guided up using the various imaging-tests guidance.
  6. A guidewire is used to guide the catheter with a rotating or sharp cutting tip across the block and maneuvered in a manner such that the plaque gets exposed to the cutter.
  7. The tip is then activated and the plaque is removed.
  8. It may be required to pass the catheter several times for the removal of large amounts of plaque.
  9. The removal of plaque may be followed by balloon angioplasty and insertion of a stent.
  10. In the case of balloon angioplasty, a catheter with a small balloon on its tip is used. The balloon is inflated at the site of blockage to compress or flatten the plaque against the wall of the artery.
  11. A stent is a mesh-like, small device that is made of metal. It may be placed inside a coronary artery to act as a support and keep the blood vessel open, thus improving the blood flow to the heart muscle.
  12. A dye contrast is then injected inside to check the latency of the arteries and whether the blood flow to the organ is restored.
  13. After the procedure is complete, the catheter is removed and the wound covered with a dressing.
  14. The procedure takes a couple of hours to complete.

Risks

The risks associated with the atherectomy procedure are:

  • Tearing and injury of the blood vessel wall
  • Bleeding around the heart
  • Chest pain
  • Heart attack
  • Embolization (the dislodged clot travels along the blood vessel to block another blood vessel)
  • Arrhythmias (disturbances in the rhythm of the heart)
  • A complete blockage of the blood vessel that may require an emergency bypass
  • Allergic reaction to the anesthesia or contrast dye used during the procedure

 

After Procedure

  1. Pressure is applied over the dressing for minimum of 20 minutes immediately after the procedure.
  2. The patient is then shifted to the recovery room, where he/she will stay for a couple of hours. The patient’s blood pressure and ECG are monitored initially every 15 minutes.
  3. Painkillers are given intravenously to relieve pain and discomfort.
  4. The patient is instructed to press on the operative site with his fingers if the patient feels the need to sneeze or cough. 
  5. The patient is advised to lie flat on his back and avoid bending the knees for approximately six hours after the procedure.
  6. The patient needs to stay in the hospital for one or two days after the procedure until the patient is stable.
  7. Avoid heavy lifting and strenuous activities for 2 to 3 weeks after the procedure.
  8. The medications that were taken previously and normal diet can be resumed when the doctor advices you for the same.
  9. A follow-up visit to the doctor is recommended seven to ten days after discharge from the hospital.

 

FAQ Section

1) What is Atherectomy ?

Atherectomy is a procedure of removing fatty plaque from the arteries. This is a minimally invasive vascular treatment that is done for patients who are diagnosed with Peripheral Arterial Disease ( PAD ). 

 

2) Which is better: Atherectomy or Angioplasty?

Angioplasty is a procedure that uses a special catheter with a balloon that inflates to open blockages in the artery and then place a stent to restore the blood flow. 
Whereas, in Atherectomy a laser or sharp blade is used to remove the plaque build up.

3) What are the advantages of Atherectomy?

The advantages of atherectomy are- small incisions, less pain, low infection risk, quick recovery time, less scaring, reduced blood loss, shorter hospital or recovery time. 

4) Which specialist does the Atherectomy procedure?

A Cardiologist or Vascular surgeon does the Atherectomy procedure.

5) What is the plaque build up, for which Atherectomy is done?

Plaque is the build up or deposition of fat, cholesterol, calcium, etc in the arteries that can block the blood flow, rupture the artery or lead to blood clot formation. This plaque is also known as Atherosclerosis and Atherectomy is done to remove this plaque.

 

6) How is Atherectomy done?

Atherectomy is done in the cardiac catheterization lab. Patient is given anesthesia/ sedatives for him/ her to relax. A Catheter tube is inserted in the artery ( artery of the upper thigh or groin artery ), it is passed to the artery that is blocked ( under guidance), dye is injected into the arteries through the catheter, Xray is taken to identify the plaque site and the artery that is blocked, the plaque is then either cut away or vaporised with the tiny blades/ laser attached to the end of the catheter. 

7) How long does it take to recover from Atherectomy?

Patient needs to rest and follow the specific instructions for 7 days to a few weeks. Patient is kept in the hospital for 1-2 days for better recovery. If it was a scheduled Atherectomy, then the patient recovers faster. However, if Atherectomy was done as an emergency procedure for heart attack, the recovery time is longer. 

 

8) What are the risks of Atherectomy?

The risks of Atherectomy includes- Embolus ( blockage ) formation from the debris of the dislodged plaque, blood vessels rupture ( due to the catheter insertion ), internal bleeding, infections, recurrence of plaque or blockage ( in cases of poor medications, follow up and poor lifestyle modifications ). 

 

9) What is the success rate of Atherectomy?

The success rate of Atherectomy is as high as 94.7%, in cases where the follow up care, post procedural medications, routine checkups, lifestyle modifications are followed adequately.

 

10) What is Laser Atherectomy?

Laser atherectomy uses a catheter that emits high energy light ( laser ) to remove the plaque and unblock the artery that is blocked. The catheter with the attached laser end, is passed through the artery to reach the blockage. Laser energy is then used to vaporize the blockage inside the vessel. 

 

11) What is the cost of Atherectomy in India?

The cost of Atherectomy in India varies across different cities and hospitals. 

Cost of Atherectomy in India
CITY COST
Cost of Atherectomy in Mumbai          INR 260000- INR 450000
Cost of Atherectomy in Bangalore INR 250000- INR 440000
Cost of Atherectomy in Delhi INR 250000- INR 440000
Cost of Atherectomy in Chennai INR 230000- INR 430000