Pumps & Pipes 1 Atherectomy and Plaque Analysis Eric Peden, MD The Methodist Hospital

Athe ….. what? Atheroma = plaque (the junk inside the arteries) ectomy = to cut out Atherectomy = removal of the plaque Pumps & Pipes 1

Atheroma = plaque (the junk inside the arteries)

ectomy = to cut out

Atherectomy = removal of the plaque

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) Pumps & Pipes 1

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)

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 Pumps & Pipes 1

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

Pumps & Pipes 1 Emboli to the foot

How to fix this plaque? Crack it open Angioplasty/Stent Scrape it out **** Bypass it Give a pill to make it go away? Pumps & Pipes 1

Crack it open

Angioplasty/Stent

Scrape it out ****

Bypass it

Give a pill to make it go away?

Scrape it out options Open surgical approach Endarterectomy Less invasive approaches Pumps & Pipes 1

Open surgical approach

Endarterectomy

Less invasive approaches

Surgical Endarterectomy Pumps & Pipes 1

Pumps & Pipes 1

Pumps & Pipes 1

Surgical Endarterectomy Great approach to some areas of the body Pretty invasive Leads to search for a better mousetrap Pumps & Pipes 1

Great approach to some areas of the body

Pretty invasive

Leads to search for a better mousetrap

Less Invasive Atherectomy Laser Atherectomy Remote Atherectomy Excisional Atherectomy Pumps & Pipes 1

Laser Atherectomy

Remote Atherectomy

Excisional Atherectomy

Pumps & Pipes 1 “ Laser”

Pumps & Pipes 1

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 Pumps & Pipes 1

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

Remote endartertectomy Similar to surgical endarterectomy but less invasive Requires special instruments to remove the plaque through a small incision Pumps & Pipes 1

Similar to surgical endarterectomy but less invasive

Requires special instruments to remove the plaque through a small incision

Pumps & Pipes 1

Pumps & Pipes 1

Pumps & Pipes 1

Pumps & Pipes 1

Pumps & Pipes 1

Remote Endarterectomy Still requires incisions Is anything ever as easy as the instructions on the box say it is???? Pumps & Pipes 1 … the search for a better mousetrap continues …

Still requires incisions

Is anything ever as easy as the instructions on the box say it is????

Excisional Atherectomy Rotor Router Devices Foxhollow Silverhawk™ Device Pumps & Pipes 1

Rotor Router Devices

Foxhollow Silverhawk™ Device

Pumps & Pipes 1 Silverhawk™ excisional atherectomy

Pumps & Pipes 1 Silverhawk™ excisional atherectomy

Pumps & Pipes 1 Silverhawk™ excisional atherectomy

Pumps & Pipes 1 Silverhawk™ excisional atherectomy

Pumps & Pipes 1 Silverhawk™ excisional atherectomy

Problems? Complications Sending debris downstream Ruptures Recurrence rates are high Pumps & Pipes 1

Complications

Sending debris downstream

Ruptures

Recurrence rates are high

Plaque Analysis Pumps & Pipes 1

Pumps & Pipes 1 Plaque Analysis

Pumps & Pipes 1 Plaque Analysis

Goals Magic pill to prevent plaque Magic pill to remove plaque Combined efficient mechanical removal with biological treatment of plaque Pumps & Pipes 1

Magic pill to prevent plaque

Magic pill to remove plaque

Combined efficient mechanical removal with biological treatment of plaque

Thank you Pumps & Pipes 1