What are the Different Types of Atherectomy?

Peripheral artery disease (PAD) is a common vascular condition that affects blood flow to the legs due to plaque buildup in the arteries. Over time, this plaque can harden and narrow the arteries, restricting blood flow and leading to symptoms like leg pain, numbness, weakness, and even non-healing wounds. Atherectomy is a minimally invasive procedure designed to remove this plaque and restore proper blood circulation to the legs. This treatment is particularly effective for patients who are not suitable candidates for angioplasty or stenting alone or those with heavily calcified plaque.

There are several types of atherectomy procedures used to treat PAD in the legs, including directional atherectomy, laser ablation atherectomy, orbital atherectomy, and rotational atherectomy. Each method has its unique mechanism for removing plaque, and the choice of procedure depends on factors such as the location and severity of the blockage, the type of plaque, and the patient’s overall health. 

1. Directional Atherectomy

Directional atherectomy is a procedure that involves shaving off plaque from the artery walls using a small rotating blade. This type of atherectomy is particularly effective for removing larger plaque deposits and is commonly used in arteries with significant blockages.

How Directional Atherectomy Works

A catheter with a cutting device is inserted into the artery and carefully guided to the site of the blockage. The blade shaves off the plaque in a controlled manner, and the removed material is collected in the catheter for removal. This technique allows for targeted plaque removal without causing significant damage to the arterial walls.

Benefits of Directional Atherectomy

• Effective for treating large plaque deposits.
• Minimizes damage to healthy arterial tissue.
• Can be combined with angioplasty or stenting for optimal results.
• Provides precise plaque removal based on the artery’s structure.

Potential Considerations

• May not be ideal for treating heavily calcified plaque.

2. Laser Ablation Atherectomy

Laser ablation atherectomy uses high-energy laser light to vaporize or break down plaque. This technique is effective for treating both soft and calcified plaque and is usually used for patients with complex or hard-to-reach blockages.

How Laser Ablation Atherectomy Works

A thin catheter with a laser fiber at its tip is inserted into the affected artery. The laser delivers short pulses of high-energy light to the plaque. The energy from the laser breaks down the plaque into microscopic particles, which are then absorbed by the bloodstream and naturally eliminated from the body. The laser can also help to open the artery and improve blood flow by breaking down clots or calcified material.

Benefits of Laser Ablation Atherectomy

• Effective for treating both soft and calcified plaque.
• Reduces the risk of restenosis (re-narrowing of the artery) by smoothing the artery walls.
• Minimally invasive with a low risk of complications.
• Can be combined with angioplasty or stenting to improve long-term results.

Potential Considerations

• Not ideal for very large or bulky plaque deposits. 
• Higher cost due to the specialized equipment required.

3. Orbital Atherectomy

Orbital atherectomy is a specialized technique used to treat heavily calcified plaque in the arteries. It involves using a rotating diamond-coated crown that sands down plaque while preserving the strength of the artery wall.

How Orbital Atherectomy Works

A catheter with a diamond-coated crown is inserted into the artery and positioned at the site of the blockage. The crown rotates at high speeds, creating an orbital motion that sands down the calcified plaque into fine particles. These particles are small enough to be safely absorbed by the bloodstream. The orbital motion allows the device to adjust to the natural contours of the artery, providing even and controlled plaque removal.

Benefits of Orbital Atherectomy

• Ideal for treating heavily calcified plaque that is resistant to other treatments.
• The orbital motion allows for precise removal while maintaining artery integrity.
• Enhances the effectiveness of subsequent balloon angioplasty or stenting.
• Minimally invasive with quick recovery times.

Potential Considerations

• May not be suitable for very soft or fibrous plaque.

4. Rotational Atherectomy

Rotational atherectomy is similar to orbital atherectomy, but uses a high-speed rotating burr instead of an orbital crown. It is especially effective for treating narrow, calcified lesions that are difficult to open with balloon angioplasty alone.

How Rotational Atherectomy Works

A catheter with a rotating burr at its tip is inserted into the artery and positioned at the blockage. The burr rotates at speeds of up to 200,000 revolutions per minute (RPM). As it spins, it grinds the calcified plaque into microscopic particles, which are small enough to be absorbed by the bloodstream. The burr is advanced slowly through the blockage, creating a smooth and open passage for blood flow.

Benefits of Rotational Atherectomy

• Effective for treating highly calcified, narrow lesions.
• Allows for precise and controlled removal of plaque.
• Improves the success rate of balloon angioplasty and stenting.
• Minimally invasive with short recovery times.

Potential Considerations

• Not suitable for soft or fibrous plaque.

Choosing the Right Atherectomy Procedure

The decision on which type of atherectomy to use depends on several factors, including:

• The type and composition of plaque (soft, calcified, fibrous).
• The location and severity of the blockage.
• The patient’s overall health and vascular anatomy.
• The presence of other diseases, such as diabetes or high blood pressure.

In many cases, atherectomy is combined with other minimally invasive procedures, such as angioplasty or stenting, to enhance the long-term success of the treatment. For example, excisional or rotational atherectomy may be used to remove the bulk of the plaque, followed by angioplasty to widen the artery and stenting to keep it open.

Is Atherectomy Right for You?

Atherectomy is a highly effective, minimally invasive treatment option for patients with PAD in the legs. The choice between excisional, laser, orbital, and rotational atherectomy depends on the type of plaque and the specific characteristics of the arterial blockage. When performed by experienced vascular specialists, atherectomy can significantly improve blood flow, relieve symptoms, and enhance the patient’s overall quality of life. If you’re experiencing symptoms of PAD, such as leg pain, weakness, or non-healing wounds, schedule an appointment with a vascular specialist at American Endovascular to determine if atherectomy is the right treatment for you.