Atherectomy is a minimally invasive technique for removing atherosclerosis from blood vessels within the body. It is an alternative to angioplasty for the treatment of peripheral artery disease, but the studies that exist are not adequate to determine whether it is superior to angioplasty.[1] It has also been used to treat coronary artery disease, albeit without evidence of superiority to angioplasty.[2]
The use of atherectomy instead of or in addition to angioplasty remains an area of controversy, as atherectomy typically involves the use of more costly disposable devices, and clear evidence to justify its use is lacking.[1] Atherectomy has high physician reimbursement relative to angioplasty alone.[3] According to the New York Times, ‘Medical device makers have bankrolled a cottage industry of doctors and clinics that perform artery-clearing procedures that can lead to amputations.’[4]
Technique
Unlike angioplasty and stents, which push plaque into the vessel wall, atherectomy cuts plaque from the wall of the artery. While atherectomy is usually employed to treat arteries it can be used in veins and vascular bypass grafts as well.
There are four types of atherectomy devices: orbital, rotational, laser, and directional.
The decision to use which type of device is made by the interventionist, based on a number of factors. They include the type of lesion being treated, the physician's experience with each device, and interpretation of the devices' risks and effectiveness, based on a review of the medical literature.
Directional atherectomy is an intravascular procedure guided by optical coherence tomography termed as lumivascular atherectomy.[5]
^Topfer, LA; Spry, C (2016). "New Technologies for the Treatment of Peripheral Artery Disease". CADTH Issues in Emerging Health Technologies. PMID30148583.
