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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