Interventional Treatment

Angioplasty

Percutaneous (through the skin) balloon angioplasty, or just "angioplasty," is a technique for enlarging an artery that is blocked or narrowed without surgery.

• A diagnostic angiogram is done first to locate the blockage or narrowing and determine the severity, because, for instance, minor blockages are treated medically.
• A thin plastic tube called a catheter is inserted into the affected artery through a needle under local anesthesia. X-ray dye or contrast is injected, x-ray films are taken and studied by the doctor. If the obstruction is significant, especially in a larger more proximal artery, angioplasty may be reasonable. The angioplasty catheter has a tiny balloon attached to the end. The balloon is inflated, pushing aside the plaque and widening the artery so that it no longer restricts blood flow.
The balloon is then deflated and removed from the artery.


Angioplasty with stent placement

Angioplasty is not a permanent solution for most people. Stenting is a technique for arteries that are very severely blocked or begin to close up again after angioplasty.

• Generally, after the stent is placed, angioplasty is carried out. Stenting and angioplasty are very useful if the obstructive lesions are localized and involve a small portion of the vessel. The majority of peripheral vascular lesions can be managed by placement of a stent, a small metal mesh sleeve that is fixed inside the narrowed artery.
• The stent holds the artery open.
• Eventually, new tissue grows over the stent. A bare metal stent was the initial approach. However, development of restenosis or fibrous scar tissue growth inside the stent leads to recurrent obstruction.
• A new generation of drug-eluting stents is especially exciting, since a drug is attached to the metal sleeve that dissolves into the blood and prevents growth factors acting to develop scar tissue. The rate of restenosis has decreased.


Atherectomy

An atherectomy is a procedure that utilizes a catheter with a sharp blade on the end to remove plaque from a blood vessel. The catheter is inserted into the artery through a small puncture in the artery, and it is performed under local anesthesia. The catheter is designed to collect the removed plaque in a chamber in the tip, which allows removal of the plaque as the device is removed from the artery. The process can be repeated at the time the treatment is performed to remove a significant amount of disease from the artery, thus eliminating a blockage from atherosclerotic disease.

Why is this atherosclerosis atherectomy procedure performed? Why do I need this procedure?

The goal of treatment is to eliminate the build-up of plaque in your arteries.

You may need this atherectomy procedure if your arteries become too narrowed or blocked from plaque inside the artery walls. If arteries are blocked, blood cannot get through to nourish the tissues, causing the muscles of the lower extremities to cramp and lose strength.

An atherectomy is especially helpful for treating blockages in arteries that occur around branches or in vessels that are not easily treated with stents.

This procedure is not ideal for everyone. Each patient is evaluated, and treatment will be individualized for the patient's circumstances.

Where is the atherectomy procedure performed and who performs this procedure?

This procedure is performed in the hospital surgical, interventional, or catheterization suite by a trained vascular surgeon.

What are the risks and potential complications of the procedure?

Your doctor will discuss the specific risks and potential benefits of the recommended procedure with you.

Atherectomy usually has no complications, but as with any surgery, there is a risk of complications, such as embolization (the dislodgement of debris that blocks the arteries in the lower part of the leg) and perforation. These complications, however, are rare. An unusual complication of atherectomy is the re-blockage of the artery (restenosis) that may occur later, especially if you smoke cigarettes.

Special precautions are taken to decrease these risks, and there may be other possible risks. When you meet with your doctor, please ask questions to make sure you understand the risks of the procedure and why the procedure is recommended.

How do I prepare for the atherectomy?

A few days before the procedure, pre-procedure tests may be performed to ensure that it is safe to continue with the procedure. You may need to discontinue certain medications before the procedure. Your health care team will provide specific instructions to help you prepare.

What happens during the procedure?

The atherosclerosis atherectomy will be performed under local anesthesia with a mild sedative given intravenously. Your surgeon will insert a catheter equipped with a sharp blade at its tip and advance it through your artery until it reaches the area of narrowing. Your surgeon will then scrape away the plaque with the catheter blade. The plaque will be collected in a chamber in the tip of the catheter for removal. The surgeon may need to pass the catheter multiple times in order to remove a significant amount of atherosclerosis.

How long does the atherectomy procedure last?

The procedure itself generally takes two hours, but the preparation and recovery time add several hours. Following the procedure, you will need to lie flat for three to six hours. The surgery may require a minimum hospital stay of one to two days.

What happens after the procedure?

You can usually begin normal activities again several days after the atherectomy. Your doctor will provide specific guidelines for your recovery.

Atherectomy with ocelot technology

Ocelot is a new advanced catheterization technology developed by Avinger, that gives physicians better visualization from inside an artery during an actual catheterization procedure. Using optical coherence tomography, or OCT, it is the first-ever chronic total occlusion (CTO) crossing catheter that uses optical coherence tomography (OCT) technology to access exact regions of the peripheral vasculature where the blockages occur, while simultaneously providing physicians with visualization for real-time navigation during an intervention.

In the past, operators have had to rely solely on x-ray as well as touch and/or feel to guide catheters through complicated blockages. With Ocelot, physicians can more accurately navigate through blocked arteries thanks to the images from inside the artery.

For those patients with blockages that are severe and difficult to penetrate with traditional catheters, the new Ocelot Catheter (unaware of advanced treatment options like Ocelot) is a great alternative and may prevent them from having to undergo an invasive bypass surgery that may result in even higher health risks and lengthy, painful recoveries.

Most patients who undergo this minimally invasive procedure are able to leave the hospital within hours, and return to normal activities within a few days.

There are typically no side effects from the treatment.