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Arterial plaque removal, medically known as atherectomy, is a procedure in which clogged arteries are opened and plaque is cut or grind away. There are different ways in which this is done. Many use a catheter that has a sharp blade on its end to manually remove built up plaque from a blood vessel. There are a variety of reasons this procedure may be done and better understanding why and how this procedure is done can help to put patients more at ease.
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Why this Procedure is Performed
Arterial plaque may have to be removed for a number of reasons. If the patient's arteries become narrowed or blocked due to plaque building up, it needs to be removed because narrowing and blocking can cause insufficient blood to flow through to nourish the patient's tissues. This procedure is often helpful in treating arterial blockages that occur within vessels or around branches that are typically not easy to treat with stents. As with all surgical procedures, atherectomy is not ideal for all patients.
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Arterial plaque removal is typically done on an inpatient basis so patients will remain in the hospital after the procedure, and in some cases, the night before the procedure. All patients will be given specific and individualized preparation instructions. All patients will have to refrain from eating or drinking for a minimum of eight hours prior to this procedure. All patients will also need a ride home from the hospital once they are discharged. If any medications need to be stopped or adjusted, the doctor will tell the patient about this in advance. Alcohol and cigarettes must also be avoided for however long the patient's doctor tells them before and after this procedure.
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For this procedure patients will be given intravenous mild sedation and local anesthesia. Once the patient is comfortable, the surgeon will take a catheter with a sharp blade at the end and carefully push it through the patient's artery until the narrowing or blockage is reached. Using the catheter blade, the built up plaque will be scraped away. There is a chamber in the catheter's tip that collects the plaque. The catheter may need to be pushed through and removed a number of times to ensure a significant amount of plaque is removed. This procedure generally takes about two hours. However, if you add in the time it takes to prepare and recover, it takes several hours longer. After the procedure is completed, the patient must lie flat for at least three to six hours. Patients may remain in the hospital for one to two days following the procedure. Full recovery usually takes several days and patients can resume activities as their doctor allows and they feel comfortable. Each patient will be sent home with detailed recovery instructions.
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This procedure is relatively safe, but there is a chance patients will experience complications after the procedure. All patients should tell their doctor about these complications. Minor complications include:
- Temporary pain
- Nausea and vomiting
- Reaction to dye or medication
- Abnormal heart beat
- Minor infections
- Allergic skin reaction to latex, dressing or tape
- Scarring or bruising at the catheter entry site
There are also major complications that may occur, though they are uncommon. If any of these occur, it is a medical emergency. These may include:
- Serious bleeding
- Heart or lung problems, like heart or lung failure or irregular heart rhythm
- Heart attack
- No reflow
- Blood clots
- Serious allergic reaction to dye or medication
- Artery reclosure
- Nerve, organ, or blood vessel damage
- Medical equipment failure
- Kidney failure possible requiring dialysis
- Other possible rare issues
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Minneapolis Heart Institute. (2010). Atherectomy. Retrieved on December 22, 2010 from Minneapolis Heart Institute: http://www.mplsheart.com/Services/Interventional/Atherectomy.aspx
Cleveland Clinic. (2010). Atherosclerosis Atherectomy. Retrieved on December 22, 2010 from Cleveland Clinic: http://my.clevelandclinic.org/services/atherectomy/vs_atherosclerosis_atherectomy.aspx