atherectomy and plaque analysis, pumpsandpipesmdhc
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Atherectomy and Plaque Analysis
Eric Peden, MDThe Methodist Hospital
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Athe ….. what?
•Atheroma = plaque (the junk inside the arteries)
•ectomy = to cut out
•Atherectomy = removal of the plaque
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The Problem?
• Plaque is clogging up the arteries
• Clogged arteries leads to downstream problems– Lack of flow to downstream structures
(ischemia)– Bits of plaque breaking off and going
downstream to damage structures (emboli)
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What is downstream?
• Everything!
• Heart – leads to heart attacks
• Brain – causes strokes
• Legs – can lead to amputations
• Almost everything else you can point to or name in your body
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Emboli to the foot
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How to fix this plaque?
• Crack it open– Angioplasty/Stent
• Scrape it out ****
• Bypass it
• Give a pill to make it go away?
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Scrape it out options
• Open surgical approach– Endarterectomy
• Less invasive approaches
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Surgical Endarterectomy
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Surgical Endarterectomy
• Great approach to some areas of the body
• Pretty invasive
• Leads to search for a better mousetrap
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Less Invasive Atherectomy
• Laser Atherectomy
• Remote Atherectomy
• Excisional Atherectomy
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“Laser”
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Laser Atherectomy
• Burns a hole right through the plaque– Can that be good for tissues?– Don’t point it at your eye!– Prohibitive restenosis rates
– New “cool laser” – pulsed energy with continuous flow around the catheter
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Remote endartertectomy
• Similar to surgical endarterectomy but less invasive
• Requires special instruments to remove the plaque through a small incision
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Remote Endarterectomy
• Still requires incisions
• Is anything ever as easy as the instructions on the box say it is????
… the search for a better mousetrap continues …
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Excisional Atherectomy
• Rotor Router Devices
• Foxhollow Silverhawk™ Device
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Silverhawk™ excisional atherectomy
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Silverhawk™ excisional atherectomy
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Silverhawk™ excisional atherectomy
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Silverhawk™ excisional atherectomy
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Silverhawk™ excisional atherectomy
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Problems?
• Complications– Sending debris downstream– Ruptures
• Recurrence rates are high
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Plaque Analysis
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Plaque Analysis
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Plaque Analysis
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Goals
• Magic pill to prevent plaque
• Magic pill to remove plaque
• Combined efficient mechanical removal with biological treatment of plaque
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Thank you