The experience of an atherectomy is very similar to other catheter-based procedures. Prior to an atherectomy, a physician will review the patient’s medical history, including all over-the-counter or prescription medications being taken.

Certain medications may need to be stopped or reduced. Patients with diabetes are encouraged to talk to their physicians about food and insulin intake. Patients are usually asked to stop eating and drinking 12 hours before the procedure.

On the day of the procedure, the patient is taken to a sterile cardiac catheterization laboratory that may resemble an operating room. There will be many monitoring devices, video display equipment and x-ray cameras. A nurse or physician will explain what will occur, and the patient is encouraged to ask any questions.

Once the patient is made comfortable, the physician inserts an intravenous (I.V.) line into the arm, usually at the back of the wrist. The I.V. allows the physician to administer  sedatives and other necessary medications, including anti-platelet medications . Heart rate and blood pressure devices will be taped to the patient’s body for on-going monitoring.

The physician usually uses the groin/upper thigh area to insert the catheter into the body, but some physicians may choose the arm or wrist instead. Whatever area is chosen, it will be cleaned, shaved and numbed with a local anesthetic. The catheter is then passed through the blood vessel (e.g., the femoral artery in the groin/upper thigh) and up into the heart. There may be some minor discomfort as it moves up the blood vessel.

Once the catheter is in place, an x-ray of the left ventricle (left ventricular angiogram) and the coronary arteries (coronary angiogram) will be taken. The angiogram helps the physician to see exactly where the blockage or narrowing is located.

The patient may feel hot or flushed for about 30 seconds as a special dye (contrast medium) is injected through the catheter and into the left ventricle. Contrast is also injected into the coronary arteries, although there is generally no sensation associated with these injections.

Once the angiogram has been reviewed, a plan for treating the blockage (usually immediately) is made by the physician. Depending on the blockage, the physician will choose the appropriate device or devices for plaque removal. These devices may include atherectomy catheters and/or balloon angioplasty catheters and stents.

The most common atherectomy-related device is the rotablator device, which uses a tiny burr to grind the plaque away. During this procedure, the patient will hear a high-pitched sound and may experience chest discomfort when the rotablator is activated. Drilling through a large blockage may be done slowly to avoid complications. It is routine to use a temporary pacemaker during rotablator procedures, because the micro-particles released during the drilling may slow the heart rate.

After the atherectomy has removed (debulked) some of the plaque, a balloon angioplasty and/or stenting may be performed. During the stenting, the physician may choose to use a drug-eluting stent instead of a “bare metal” stent. Drug-eluting stents have been coated with special drugs that help prevent restenosis, or the re-closure of the artery.

Restenosis can occur after an atherectomy, angioplasty or stenting procedure. If it does, another procedure may be necessary, or if the arterial blockage is more severe, the physician may recommend coronary artery bypass graft (CABG).

Once the treatment is finished, final pictures are taken and the catheters are removed, completing the procedure.