A procedure called atherectomy is occasionally used to open up blocked arteries in the legs or even the coronary arteries in the heart.
Atherectomy uses a catheter with various designs that can either remove or shave off plaque in your blood vessels and helps restore blood flow.
Atherectomy is especially helpful for treating blockages in arteries that occur around branches or in calcified vessels that are difficult to treat with balloons and/or stents.
This procedure is not ideal for everyone, though. You will need a careful evaluation by a vascular expert to be considered for this procedure. The decision is typically made after you undergo a lower extremity angiogram (X-ray that looks at blood flow).
How it works
In atherectomy, a catheter that contains a sharp blade, a cutter, a crown, or laser at its tip travels through your blood vessel to the area where blockage occurs. These devices remove, vaporize, or sand plaque.
Currently, atherectomy is an option for some patients who suffer from peripheral arterial disease (PAD), which is atherosclerosis or blockage in blood vessels in the legs or lower extremities.
The right tool for each case
Currently, the FDA has approved four devices for use in atherectomy:
- Turbohawk™ (Covidien)
- Spectranetic’s Laser
- Diamondback 360 PAD System (CSI Solutions Inc.)
- Pathway™ (Boston Scientific).
Mehdi Shishehbor, DO, Director of Endovascular Services in Cleveland Clinic’s Department of Cardiovascular Medicine, says that these four devices are not all the same and have subtle design differences. “In our practice, we use these devices to facilitate treatment of lower extremity arterial blockages. Each device has a specific mechanism for removing or modifying the plaque inside the arteries.”
That means that in individual cases, one specific type of device could offer particular benefits over the others, he says. “Although all four devices are used for atherectomy, we believe that each device should be used in the appropriate patient for the right lesion. Each patient and lesion is not the same and each device is not the same; the right lesion must be matched to the right device.”
Risks and complications
Atherectomy is a valuable tool for treating clogged arteries. However, there are some risks associated with its use.
Dr. Shishehbor explains, “Although these devices are useful in certain situations, they have been associated with complications such as perforation, embolization (plaque breaking off and traveling downstream to the lower leg) and dissection (tearing of the artery).”
Procedure and device selection
It is important to know that atherectomy is only one tool that vascular specialists have to offer when treating peripheral artery disease. Results of angiogram studies help doctors decide whether or not atherectomy could be helpful or if other treatments would be more beneficial. Before the procedure begins, experts assess the risk and benefit of performing atherectomy. If they decide to move forward, they then assess which device should be used in that particular situation.
As of yet, no one knows exactly how effective atherectomy treatment is. What little data that exists comes from a single, limited non-randomized clinical study.
No one procedure or device can cure atherosclerosis. A comprehensive evaluation by an expert in vascular disease — encompassing risk factor modification, prevention and treatment — is essential, and perhaps the most valuable tool of all.