Catherine Spader, RN
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:
You will dress in a patient gown and lie on a procedure table.
Your team will insert an intravenous (IV) line to provide fluids and medications.
Your team will attach devices to monitor your heart rate, blood pressure, and other functions.
You will have a blood test to verify normal kidneys function and blood clotting.
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.
You may have medication to prevent blood clots from forming in your arteries. You may also have medications to prevent spasms in your arteries.
The procedure team will shave and clean your groin or arm. Your doctor will numb the area and make a small incision.
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.
Your doctor will inject a contrast agent through the catheter to help improve the quality of the X-ray images.
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.
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.
Will I feel pain?
Your comfort and relaxation are important to you and your care team. You may feel a pinch or prick during the IV placement and brief stinging during injection of the local anesthetic. You may also feel pressure as your doctor makes the incision and inserts the catheter. There may also be some chest discomfort during the procedure.
Tell your doctor if you have pain or discomfort, even if it is minor. You will have enough sedative medications to keep you relaxed and comfortable.
What are the risks and potential complications of coronary atherectomy?
Complications of coronary atherectomy are uncommon, but any procedure involves risks and possible complications that may become serious in some cases. Complications can develop during the procedure or recovery.
Complications of coronary atherectomy include:
Abnormal heart rhythms
Adverse reaction or problems related to sedation or medications, such as an allergic reaction and problems with breathing
Blood clots within your arteries or recurrence of artery narrowing or blockage
Damage to an artery from the catheter or instruments
Embolization, which occurs when dislodged plaque travels and blocks other arteries in the body
Exposure to ionizing radiation, which may be harmful in excessive doses
Chest pain, heart attack, or stroke
Kidney injury from the contrast agent, especially if you have kidney problems
Reducing your risk of complications
You can reduce the risk of some complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
Informing your doctor if you have kidney disease or diabetes
Informing your doctor or radiologist if you are nursing or of any possibility of pregnancy
Notifying your doctor immediately of any concerns such as bleeding, fever, or increase in pain
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my coronary atherectomy?
You are an important member of your own healthcare team. The steps you take before your procedure can improve your comfort and outcome.
You can prepare for coronary atherectomy by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Following instructions about eating and drinking before coronary atherectomy
Taking or stopping medications exactly as directed. Your doctor will give you specific instructions about taking your medications.
Questions to ask your doctor
Preparing for coronary atherectomy can be stressful. It is common for patients to forget to some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before atherectomy and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need coronary atherectomy? Are there any other options for treating my condition?
How long will the procedure take? When can I go home?
What restrictions will I have after the procedure? When can I return to work and other activities?
What kind of assistance will I need at home? Will I need a ride home?
How do I take my medications?
How will you treat my pain?
What other tests or treatments might I need?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my coronary atherectomy?
Knowing what to expect after coronary atherectomy can help you get back to your everyday life as soon as possible.
How will I feel after the coronary atherectomy?
You may have mild drowsiness from the sedative medications after the procedure. It is common to experience mild tenderness and bruising at the catheter incision site. Tell your doctor if you are uncomfortable.
Your activities will be restricted following coronary atherectomy. You may need to lie down with your leg or arm straight for six hours following coronary atherectomy. You may also take new medications to prevent blood clots and spasms in your arteries. You may need to drink extra fluids to flush out the contrast agent used during the procedure.
Follow your doctor’s instructions for eating, drinking, resting, and taking medications after coronary atherectomy.
When can I go home?
You will probably spend one to two days in the hospital for observation after coronary atherectomy. This is true even if you did not have general anesthesia. You will go home when your doctor decides that your condition is stable.
You will need a ride home. You will need to take it easy for three to five days or more as directed by your doctor. Then you may begin mild activities and increase them gradually. Avoid heavy lifting until your doctor says it is safe to do so.
When should I call my doctor?
It is important to keep your follow-up appointments after coronary atherectomy Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Color change in the arm or leg that was used to insert the catheter
Numbness or a feeling of coolness in the arm or leg that was used to insert the catheter
Pain that is not controlled by your pain medication
Unusual swelling, redness or warmth around your incision
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