Atherectomy

What is Atherectomy?

Atherectomy is a minimally invasive procedure that physically removes atherosclerotic plaque from inside a narrowed or blocked artery, restoring blood flow to the affected area. Unlike angioplasty, which pushes plaque to the side by inflating a balloon, atherectomy cuts, grinds, or vaporizes the plaque, removing it from the vessel entirely.

Atherectomy is commonly used to treat peripheral arterial disease (PAD) — a circulation problem in which the arteries carrying blood to the legs become narrowed by the buildup of cholesterol, fat, and scar tissue (plaque). It is particularly effective for calcified or hardened plaque that may not respond well to balloon angioplasty alone.

How Does Atherectomy Work?

Atherectomy is performed under local anesthesia as an outpatient procedure. Your physician guides a specialized catheter through the arterial system to the site of the blockage using fluoroscopy (real-time X-ray imaging).

Types of Atherectomy

Several atherectomy methods are available, and your physician will select the approach best suited to your specific blockage:

Rotational Atherectomy The catheter features a high-speed rotating burr or drill at its tip. As it spins, it grinds the plaque into microscopic particles small enough to be safely washed away in the bloodstream. This method is particularly effective for heavily calcified plaque.

Directional Atherectomy A small blade at the end of the catheter shaves plaque away from the artery wall in a controlled direction. The catheter has a collection chamber that captures the removed plaque as it exits the artery, preventing debris from traveling downstream.

Laser Atherectomy A laser fiber at the catheter tip delivers targeted energy that vaporizes plaque on contact. This method is useful for treating blockages that are difficult to reach or that have a mix of plaque types.

Orbital Atherectomy Similar to rotational atherectomy but with a modified, diamond-coated crown that orbits within the artery. The device sands away plaque while conforming to the natural shape of the vessel. It is one of the newest techniques and is effective for both calcified and non-calcified plaque.

The Procedure

1. Access: A small puncture is made in the skin, typically in the groin, and local anesthetic is applied.
2. Catheter guidance: The specialized atherectomy catheter is threaded through the arterial system to the blockage using fluoroscopic imaging.
3. Plaque removal: The appropriate atherectomy technique is used to remove plaque from the artery. The physician may make multiple passes to clear the blockage adequately.
4. Assessment: Contrast dye is injected to evaluate blood flow through the treated artery.
5. Additional treatment: If needed, balloon angioplasty and/or stent placement may be performed after atherectomy to further optimize the artery opening.
6. Completion: The catheter is removed and the access site is bandaged. No stitches are typically required.

The procedure usually takes 1-2 hours, depending on the number and complexity of blockages being treated.

Why Might Atherectomy Be Recommended?

Your physician may recommend atherectomy instead of or in addition to angioplasty in several situations:

• Heavily calcified plaque: Hard, calcified deposits that resist compression by a balloon may respond better to physical removal
• Severely narrowed arteries: Blockages too tight for balloon advancement may need to be debulked first with atherectomy
• Blockages at artery branches: Plaque near vessel branch points may be better treated with atherectomy to avoid compromising the branch
• Areas not suitable for stents: Some locations in the arterial system are subject to bending and compression, making stents less ideal. Atherectomy can restore blood flow without a permanent implant
• In-stent restenosis: When a previously placed stent re-narrows due to tissue growth, atherectomy can remove the obstructing tissue
• Long or diffuse blockages: Extended areas of plaque buildup that would require multiple stents may be better treated with atherectomy

Who is a Candidate?

Atherectomy may be appropriate for patients who:

• Have been diagnosed with PAD causing leg pain, cramping, or limited walking ability
• Have arterial blockages confirmed by imaging (ultrasound, CT angiography, or angiogram)
• Have not achieved adequate symptom relief with lifestyle changes and medications
• Have calcified or complex blockages not ideal for balloon angioplasty alone
• Need treatment to prevent tissue loss or limb-threatening ischemia

Benefits of Atherectomy

• Removes plaque entirely: Unlike angioplasty, which compresses plaque, atherectomy removes it from the artery [1]
• Effective on calcified plaque: Can treat hardened deposits that resist other methods
• May reduce need for stents: Plaque removal can restore an adequate artery opening without a permanent implant
• Minimally invasive: Performed through a small puncture under local anesthesia
• Outpatient procedure: Most patients go home the same day
• Can be combined with other treatments: Often used alongside angioplasty and stenting for comprehensive treatment
• Immediate blood flow improvement: Results are apparent right away

What to Expect During Recovery

• Day of procedure: You will rest for several hours while the access site is monitored. Most patients go home the same day.
• First 24-48 hours: Avoid strenuous activity and heavy lifting. Keep the puncture site clean and dry.
• Medications: Antiplatelet medications (such as aspirin or clopidogrel) are typically prescribed to keep the treated artery open.
• Activity: Walking is encouraged within a day or two. Gradually resume normal activities over the following week.
• Follow-up: Your physician will schedule follow-up imaging to monitor the treated artery and assess long-term results.

Potential Risks

Atherectomy is generally safe when performed by experienced vascular specialists. Possible risks include:

• Bruising or bleeding at the access site
• Arterial perforation or dissection (rare)
• Distal embolization (plaque fragments traveling downstream) — minimized by embolic protection devices when indicated
• Restenosis (re-narrowing over time)
• Contrast dye allergic reaction
• Kidney effects from contrast dye

Your physician will discuss all potential risks and take careful steps to minimize complications during the procedure.

Why Choose Preferred Vascular Group?

Our board-certified vascular specialists are experienced in all atherectomy techniques and will select the optimal approach for your specific condition. At Preferred Vascular Group, you receive:

• Expert interventional care using the latest atherectomy devices and techniques
• Comprehensive evaluation to determine the best treatment strategy for your arterial disease
• Minimally invasive, outpatient treatment with rapid recovery
• Combined approach when needed — atherectomy, angioplasty, and stenting in a single session
• Ongoing monitoring to ensure long-term results
• Eight convenient locations across Georgia and Ohio

If you have been diagnosed with peripheral arterial disease or other arterial blockages, our specialists can determine whether atherectomy is the right treatment to restore your circulation and relieve your symptoms.

References

1. Defined in Cochrane Reviews. “Atherectomy for peripheral arterial disease.” Cochrane Database of Systematic Reviews, 2020. PubMed
2. Defined et al. “The role of atherectomy in the treatment of lower extremity peripheral artery disease.” Vascular Medicine, 2012. PubMed
3. Defined et al. “Atherectomy — The Options, the Evidence, and When Should It Be Used.” Techniques in Vascular and Interventional Radiology, 2024. PubMed