What is coronary atherectomy?

Coronary atherectomy is a procedure to open a coronary artery that is blocked or narrowed by plaque. Coronary arteries are blood vessels that supply your heart muscle with blood. Coronary atherectomy improves blood flow to your heart muscle. It is a treatment for coronary artery disease (CAD), which is a risk factor for a heart attack.

Coronary atherectomy is a type of coronary angioplasty. It is only one method of treating narrowed or blocked coronary arteries. Discuss all of your different treatment options with your doctor to understand which options are right for you.

Other procedures that may be performed

Your doctor may recommend other procedures to diagnose or treat certain conditions. These include:

  • Balloon angioplasty uses a balloon to compress plaque against the artery wall and restore blood flow.
  • Coronary angiography allows your doctor to take pictures or images, called an angiogram, of your coronary arteries.
  • Minimally invasive bypass grafting provides a new route around diseased coronary arteries with healthy vessels taken from other places in your body. You may have general anesthesia if your doctor combines this surgery with atherectomy.
  • Stenting involves inserting a mesh tube (stent) inside the coronary artery. The stent expands and remains in place to keep the artery open after atherectomy.

Why is coronary atherectomy performed? 

Coronary atherectomy treats coronary artery disease (CAD). Coronary atherectomy reduces the risk of death in some people with CAD.

CAD occurs when fatty deposits build up on coronary artery walls and harden into a substance called plaque. As plaque builds on coronary artery walls, the artery narrows and hardens. 

Eventually, a serious blockage can occur and blood will not flow through the coronary artery properly. The blockage increases the risk that a blood clot forms and totally blocks the coronary artery (heart attack). You may be a candidate for coronary atherectomy if:

  • You have angina (chest pain) and shortness of breath with mild or moderate exertion. Angina and shortness of breath are symptoms of CAD.
  • You have had a heart attack.
  • You have a coronary bypass graft that has closed or narrowed.
  • You have only one or two blocked or narrowed coronary arteries. If more coronary arteries are involved, your doctor may recommend coronary bypass grafting instead of atherectomy.
  • Your doctor determines that the plaque will respond to atherectomy and that it can be reached with a catheter.
  • Your symptoms do not respond to medications.
  • Your symptoms interfere with daily activities.

Who performs coronary atherectomy?

The following specialists perform coronary atherectomy. 

  • Cardiologists specialize in diagnosing and treating conditions of the heart and its blood vessels.
  • Interventional cardiologists specialize in diagnosing and treating heart disease using catheter procedures and radiological imaging. 
  • Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons.

How is coronary atherectomy performed?

Your coronary atherectomy will be performed in a cardiac catheterization laboratory, often abbreviated “cath lab.” A cath lab is a room in a hospital or clinic that has special X-ray machines and video screens to perform atherectomy.

The procedure takes one to two hours and generally includes these steps:

  1. You will dress in a patient gown and lie on a procedure table.
  2. Your team will insert an intravenous (IV) line to provide fluids and medications.
  3. Your team will attach devices to monitor your heart rate, blood pressure, and other functions.
  4. You will have a blood test to verify normal kidneys function and blood clotting.
  5. You will have a light sedative to make you drowsy and relaxed. Patients sometimes have deeper sedation or anesthesia through the IV. In this case, you are more relaxed and unaware of the procedure and may not remember it. Your doctor may use general anesthesia if atherectomy is combined with a more extensive procedure.
  6. You may have medication to prevent blood clots from forming in your arteries. You may also have medications to prevent spasms in your arteries.
  7. The procedure team will shave and clean your groin or arm. Your doctor will numb the area and make a small incision.
  8. Your doctor will insert a tiny tube (catheter) and guide wire through the incision. The catheter is fed into the artery that needs atherectomy. X-rays guide the wire to the exact location.
  9. Your doctor will inject a contrast agent through the catheter to help improve the quality of the X-ray images.
  10. Your doctor will grind or shave away the blockage to open or widen your coronary artery. A stent may be placed to keep it open. 
  11. Your team may take additional X-rays to verify that blood is flowing as expected. Your doctor will then remove the catheter and close the catheter site.