Atherectomy and Plaque Analysis, pumpsandpipesmdhc
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    Atherectomy and Plaque Analysis, pumpsandpipesmdhc Atherectomy and Plaque Analysis, pumpsandpipesmdhc Presentation Transcript

    • 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
    • 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
    • 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
    • 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
    • Scrape it out options
      • Open surgical approach
        • Endarterectomy
      • Less invasive approaches
      Pumps & Pipes 1
    • 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
    • Less Invasive Atherectomy
      • Laser Atherectomy
      • Remote Atherectomy
      • Excisional Atherectomy
      Pumps & Pipes 1
    • 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
    • Remote endartertectomy
      • 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
    • 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 …
    • Excisional Atherectomy
      • Rotor Router Devices
      • Foxhollow Silverhawk™ Device
      Pumps & Pipes 1
    • 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
    • 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
    • Thank you Pumps & Pipes 1