Pumps & Pipes 1 Atherectomy and Plaque Analysis Eric Peden, MD The Methodist Hospital
Athe ….. what? <ul><li>Atheroma = plaque (the junk inside the arteries) </li></ul><ul><li>ectomy = to cut out </li></ul><u...
The Problem? <ul><li>Plaque is clogging up the arteries </li></ul><ul><li>Clogged arteries leads to downstream problems </...
What is downstream? <ul><li>Everything! </li></ul><ul><li>Heart – leads to heart attacks </li></ul><ul><li>Brain – causes ...
Pumps & Pipes 1 Emboli to the foot
How to fix this plaque? <ul><li>Crack it open </li></ul><ul><ul><li>Angioplasty/Stent </li></ul></ul><ul><li>Scrape it out...
Scrape it out options <ul><li>Open surgical approach </li></ul><ul><ul><li>Endarterectomy  </li></ul></ul><ul><li>Less inv...
Surgical Endarterectomy Pumps & Pipes 1
Pumps & Pipes 1
Pumps & Pipes 1
Surgical Endarterectomy <ul><li>Great approach to some areas of the body </li></ul><ul><li>Pretty invasive </li></ul><ul><...
Less Invasive Atherectomy <ul><li>Laser Atherectomy </li></ul><ul><li>Remote Atherectomy </li></ul><ul><li>Excisional Athe...
Pumps & Pipes 1 “ Laser”
Pumps & Pipes 1
Laser Atherectomy <ul><li>Burns a hole right through the plaque </li></ul><ul><ul><li>Can that be good for tissues? </li><...
Remote endartertectomy <ul><li>Similar to surgical endarterectomy but less invasive </li></ul><ul><li>Requires special ins...
Pumps & Pipes 1
Pumps & Pipes 1
Pumps & Pipes 1
Pumps & Pipes 1
Pumps & Pipes 1
Remote Endarterectomy <ul><li>Still requires incisions </li></ul><ul><li>Is anything ever as easy as the instructions on t...
Excisional Atherectomy <ul><li>Rotor Router Devices </li></ul><ul><li>Foxhollow Silverhawk™ Device </li></ul>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? <ul><li>Complications </li></ul><ul><ul><li>Sending debris downstream </li></ul></ul><ul><ul><li>Ruptures </li><...
Plaque Analysis Pumps & Pipes 1
Pumps & Pipes 1 Plaque Analysis
Pumps & Pipes 1 Plaque Analysis
Goals <ul><li>Magic pill to prevent plaque </li></ul><ul><li>Magic pill to remove plaque </li></ul><ul><li>Combined effici...
Thank you Pumps & Pipes 1
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Atherectomy and Plaque Analysis, pumpsandpipesmdhc

  1. 1. Pumps & Pipes 1 Atherectomy and Plaque Analysis Eric Peden, MD The Methodist Hospital
  2. 2. Athe ….. what? <ul><li>Atheroma = plaque (the junk inside the arteries) </li></ul><ul><li>ectomy = to cut out </li></ul><ul><li>Atherectomy = removal of the plaque </li></ul>Pumps & Pipes 1
  3. 3. The Problem? <ul><li>Plaque is clogging up the arteries </li></ul><ul><li>Clogged arteries leads to downstream problems </li></ul><ul><ul><li>Lack of flow to downstream structures (ischemia) </li></ul></ul><ul><ul><li>Bits of plaque breaking off and going downstream to damage structures (emboli) </li></ul></ul>Pumps & Pipes 1
  4. 4. What is downstream? <ul><li>Everything! </li></ul><ul><li>Heart – leads to heart attacks </li></ul><ul><li>Brain – causes strokes </li></ul><ul><li>Legs – can lead to amputations </li></ul><ul><li>Almost everything else you can point to or name in your body </li></ul>Pumps & Pipes 1
  5. 5. Pumps & Pipes 1 Emboli to the foot
  6. 6. How to fix this plaque? <ul><li>Crack it open </li></ul><ul><ul><li>Angioplasty/Stent </li></ul></ul><ul><li>Scrape it out **** </li></ul><ul><li>Bypass it </li></ul><ul><li>Give a pill to make it go away? </li></ul>Pumps & Pipes 1
  7. 7. Scrape it out options <ul><li>Open surgical approach </li></ul><ul><ul><li>Endarterectomy </li></ul></ul><ul><li>Less invasive approaches </li></ul>Pumps & Pipes 1
  8. 8. Surgical Endarterectomy Pumps & Pipes 1
  9. 9. Pumps & Pipes 1
  10. 10. Pumps & Pipes 1
  11. 11. Surgical Endarterectomy <ul><li>Great approach to some areas of the body </li></ul><ul><li>Pretty invasive </li></ul><ul><li>Leads to search for a better mousetrap </li></ul>Pumps & Pipes 1
  12. 12. Less Invasive Atherectomy <ul><li>Laser Atherectomy </li></ul><ul><li>Remote Atherectomy </li></ul><ul><li>Excisional Atherectomy </li></ul>Pumps & Pipes 1
  13. 13. Pumps & Pipes 1 “ Laser”
  14. 14. Pumps & Pipes 1
  15. 15. Laser Atherectomy <ul><li>Burns a hole right through the plaque </li></ul><ul><ul><li>Can that be good for tissues? </li></ul></ul><ul><ul><li>Don’t point it at your eye! </li></ul></ul><ul><ul><li>Prohibitive restenosis rates </li></ul></ul><ul><ul><li>New “cool laser” – pulsed energy with continuous flow around the catheter </li></ul></ul>Pumps & Pipes 1
  16. 16. Remote endartertectomy <ul><li>Similar to surgical endarterectomy but less invasive </li></ul><ul><li>Requires special instruments to remove the plaque through a small incision </li></ul>Pumps & Pipes 1
  17. 17. Pumps & Pipes 1
  18. 18. Pumps & Pipes 1
  19. 19. Pumps & Pipes 1
  20. 20. Pumps & Pipes 1
  21. 21. Pumps & Pipes 1
  22. 22. Remote Endarterectomy <ul><li>Still requires incisions </li></ul><ul><li>Is anything ever as easy as the instructions on the box say it is???? </li></ul>Pumps & Pipes 1 … the search for a better mousetrap continues …
  23. 23. Excisional Atherectomy <ul><li>Rotor Router Devices </li></ul><ul><li>Foxhollow Silverhawk™ Device </li></ul>Pumps & Pipes 1
  24. 24. Pumps & Pipes 1 Silverhawk™ excisional atherectomy
  25. 25. Pumps & Pipes 1 Silverhawk™ excisional atherectomy
  26. 26. Pumps & Pipes 1 Silverhawk™ excisional atherectomy
  27. 27. Pumps & Pipes 1 Silverhawk™ excisional atherectomy
  28. 28. Pumps & Pipes 1 Silverhawk™ excisional atherectomy
  29. 29. Problems? <ul><li>Complications </li></ul><ul><ul><li>Sending debris downstream </li></ul></ul><ul><ul><li>Ruptures </li></ul></ul><ul><li>Recurrence rates are high </li></ul>Pumps & Pipes 1
  30. 30. Plaque Analysis Pumps & Pipes 1
  31. 31. Pumps & Pipes 1 Plaque Analysis
  32. 32. Pumps & Pipes 1 Plaque Analysis
  33. 33. Goals <ul><li>Magic pill to prevent plaque </li></ul><ul><li>Magic pill to remove plaque </li></ul><ul><li>Combined efficient mechanical removal with biological treatment of plaque </li></ul>Pumps & Pipes 1
  34. 34. Thank you Pumps & Pipes 1

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