Heart Center

Technology & Procedures

Rotoblator

Athrectomy is a procedure that relieves symptoms of coronary artery disease by improving blood flow to your heart. During athrectomy, a catheter (a thin, soft, flexible tube) carrying a special cutting or grinding device clears the blockage.

An athrectomy is a sterile procedure. Upon entering the Cath Lab area, you will be placed on an exam table. Monitoring equipment, such as a blood pressure cuff, pulse oximeter, and EKG will be placed for use during your procedure. In most cases, the right groin area will be shaved prior to the procedure and washed with iodine soap. If you have any allergies to iodine, please let us know prior to the procedure. A sterile drape will be placed to cover you from the neck down to the foot of the bed to ensure a sterile area. It will be very important that you not touch your groin area or move your hands; the staff will help you with any problems.

Depending upon the physician and patient preference, relaxing medication will be available to make your procedure as comfortable as possible. The physician will arrive and xylocaine will be used as a local anesthesia to numb the groin area. A catheter introducer will be placed in your right femoral artery. The physician will be able to use three separate catheters to look at the left coronary artery, right coronary artery and left ventricular chamber. A contrast media or x-ray is used to illuminate the coronaries for evaluation of blockage in your arteries. Your doctor will be able to see your artery on an angiogram (moving x-ray picture). You may feel some discomfort in your chest during the athrectomy. Tell your doctor if you do. A guide wire is inserted through the catheter and moved to the blocked section in your artery. Your doctor will select the type of athrectomy procedure best suited to treat your blockage.

Rotational Athrectomy uses an abrasive burr near the tip of the catheter to grind the plaque into small particles that float harmlessly away in the bloodstream.
Directional Coronary Athrectomy (DCA) positions the catheter window over the blockage. A rotating blade shaves the plaque and collects it in the catheter tip.
Extraction Athrectomy uses an abrasive burr near the tip of the catheter to grind the plaque into small particles that are collected on the tip and extracted.

After the athrectomy, your doctor may do an angioplasty using a balloon catheter to compress any remaining plaque against the arterial wall. The catheters and guide wire are removed. The artery is open, and blood flow to the heart muscle increases.

An athrectomy usually lasts 1 to 2 hours. Your family will be placed in the Cardiovascular Waiting Room during your procedure. If the procedure should last longer than the designated time, we will call the Hostess or come out and let your family know about any delays.

While you are recovering in the hospital, the introducing sheath will be left in several hours or overnight. You will have to lie flat and not move your leg for 6 to 10 hours after the sheath is removed. The nurse frequently checks your pulse and blood pressure and checks the insertion site for bleeding. You'll remain attached to a heart monitor and an IV line that provides fluids and medications over several hours after the procedure. Frequent blood tests will help your doctor adjust the dosage of your anticoagulant medication. Your activity level well be restricted for the first few days you are recovering.

You'll be carefully watched during and after the procedure. A nurse checks your blood pressure and insertion sight frequently to make sure there is no bleeding. Your doctor may also come in to check on you. The x-ray contrast liquid may cause you to urinate more than usual, and you may be asked to drink a lot of fluid to help flush the contrast liquid out of your system.

Tell your nurse if:

•   You feel any chest pain or discomfort at the insertion sight
•   The arm or leg used for insertion becomes numb or cold
•   You feel warmth or wetness around the insertion site, a sign that you may be bleeding.

Your doctor will discuss your test results with you. Your nurse will give you instructions for caring for yourself when you go home. You should be able to walk without much discomfort before you leave the hospital. Have a family member or friend drive you home from the hospital. Most people can return to normal activities a day or two after they come home. It's a good idea to avoid heavy lifting and only engage in light activities for a few days. You may find a small bruise or lump about the size of an olive under your skin at the insertion site. Also, the skin in that area will usually bruised. These are common side effects and should disappear within a few weeks.

Call your doctor if:

•   You have angina (chest pain)
•   The insertion site begins to bleed
•   You feel any chest pain or discomfort at the insertion site
•   The arm or leg in which the catheter was inserted feels cold or numb
•   The bruising or swelling increases

Your doctor may prescribe aspirin or another medication to help prevent blood clots. You may also take medication to prevent angina. Be sure to tell your doctor if any of the medications cause side effects. Don't stop taking any medication unless your doctor tells your to.

In addition to regular checkups, your doctor usually schedules some tests, including an exercise stress test, within the first six months after your athrectomy. These test check to see whether your artery has remained open.

During the first six months after your athrectomy, your treated artery may narrow again. Tell your doctor if you feel symptoms like the ones you had before your athrectomy. Your doctor may recommend further testing or other procedure to treat the problem.

Angioplasty can help in the treatment of coronary artery disease, but it is not a true cure. You need to change any unhealthy habits (also called risk factors) that helped create your heart problems in the first place. Some risk factors are smoking, eating too much fat and salt and not getting enough exercise. Making changes to reduce risk factors can help keep your heart condition form getting worse and may even improve the health of your heart.

If you have any questions or concerns, please call the your doctor.