Atherectomy

Atherectomy is a peripheral intervention that opens arteries blocked by plaque (atherosclerosis). During atherectomy, your provider uses a catheter (a long, narrow tube) with a sharp blade, laser, or rotating device on the end to scrape away, dissolve, or break up plaque without making a large incision.

If atherosclerosis occurs in the arteries leading to the heart (coronary arteries), it’s called coronary artery disease. Coronary artery disease is the most common type of heart disease. Without treatment, it can significantly block blood flow to the heart and cause a heart attack.

If atherosclerosis affects any arteries outside the heart, it’s called, peripheral artery disease (PAD). PAD affects more than six million adults over 40 in the United States. Without treatment, it can cause severe pain, slow- or non-healing wounds, and an increased risk of limb loss.

A rotational atherectomy is a type of atherectomy that uses a revolving device placed on the tip of the catheter. The device rotates at very high speeds to break up plaque into tiny particles small enough to flow through the blood safely without blocking blood vessels.

The type of atherectomy technique your provider uses varies depending on the extent of the plaque buildup. Your doctor will explain what technique they are using and answer any questions you have before the procedure.

People with severe atherosclerosis may need an atherectomy. Your provider may recommend this procedure if you have very hardened plaque. Or it may be a treatment for people who have already had procedures such as angioplasty and stenting but still have plaque blocking blood flow. Your doctor may recommend atherectomy to break up tough plaque first, then follows up with angioplasty and stenting.

Your care team gives you specific instructions to prepare before an atherectomy. You may need to stop taking certain medications, such as blood thinners, for a brief period. The care team will likely instruct you to stop eating or drinking by midnight on the day of the procedure.

An atherectomy procedure usually lasts around two hours. You have anesthesia to keep you comfortable. An interventional cardiologist or vascular surgeon, interventional echocardiographic, and an anesthesia specialist work together to perform the procedure.

During an atherectomy, your doctor:

1. Makes a small incision in your groin and inserts a catheter with a laser, revolving device or sharp blade into a blood vessel
2. Guides the catheter through the blood vessel to the blocked artery
3. Injects a contrast dye through the catheter. They watch the contrast dye move through your arteries to confirm that the blockage has been cleared.
4. Removes plaque by scraping it away with the blade, dissolving it with the laser, or breaking it up with the revolving device
5. Removes the catheter and applies pressure and a bandage to stop any bleeding at the catheter insertion site

Most people experience an immediate improvement in blood flow after atherectomy and improvement in symptoms such as leg pain, chest pain, leg swelling, or shortness of breath. Because it is a minimally invasive procedure without a large incision, many people have less blood loss and pain and fewer complications. Atherectomy typically has a quicker recovery with a shorter hospital stay than traditional open surgical procedures.

An atherectomy is typically a low-risk procedure. Complications are rare, especially when the procedure is performed by an experienced provider. Rarely, a small piece of plaque can break off and travel to another blood vessel. Other potential risks of an atherectomy can include:

• Arrhythmias (irregular heart rhythms)
• Bleeding
• Blood vessel damage
• Heart attack
• Infection

You may need to lie on your back for several hours after the procedure to prevent bleeding at the catheter insertion site. Most people stay in the hospital overnight and return home the next day. You can usually resume your usual activities within several days, but may need to wait two to three weeks to resume strenuous activity. You usually have a follow-up with your provider within seven to 10 days.

Tell your provider if you experience any signs of complications after an atherectomy, including:

• Pain in your leg or groin
• Redness, swelling, or discharge around the catheter insertion site
• Temperature changes in the treated leg

Penn physicians are experts in atherectomy, with years of experience and a track record of excellence. When you choose our team, you benefit from:

• Team-based care: Our interventional cardiologists work closely with multiple specialists, including the experts in the Penn Vascular Surgery and Endovascular Therapy Program. This collaborative approach helps ensure we find and implement the best treatment option for your needs.
• Range of treatment options: We were part of the first trial for shockwave intravascular lithotripsy, making us one of the first in the world to offer an alternative to the rotational atherectomy. This treatment uses sonic pressure waves and heat to break up plaque, which is more effective in some patients.
• Subspecialized experts: Penn interventional cardiologists subspecialize in specific diagnoses, treatments, and techniques, including peripheral interventions. This niche expertise means we bring you advanced treatments from specialists with extensive experience.