Northside Cardiology PLLC, Florida

Directional coronary atherectomy (DCA) is a technique by which a catheter with a small mechanically-driven cutter shaves the plaque and stores it in a collection chamber. The plaque is then removed from the artery when the device is withdrawn.

Mechanical rotational atherectomy is a technique that uses a diamond-shaped burr that rotates and shaves the plaque into tiny particles, which then pass through the circulatory system.

You will probably be asked not to eat or drink anything after midnight on the night before your procedure. If you have not already stopped smoking, your doctor may recommend that you do so prior to being admitted to the hospital in preparation for the upcoming procedure.

Some hospitals do not allow patients to wear dentures or glasses during the procedure. If you have dentures or glasses and want to wear them, ask your nurse about hospital policy.

Diagnostic Tests:
Upon admission to the hospital, your preparation prior to treatment will include tests such as an ECG, a chest x-ray, and routine blood tests.

Talking with your doctor:
Your doctor will visit you in your hospital room to discuss the procedure in detail and tell you the approximate time the procedure is scheduled. He or she will explain the possible risks and benefits and answer any questions you or your family may have.
Be sure to tell your doctor what medications you are currently taking. You should also tell your doctor about any allergies you have, especially to x-ray dye or iodine. These allergies may require additional medication prior to a procedure. It is also important to let your doctor know if you cannot take aspirin, since this and other medications are usually begun prior to a procedure and continued for several months thereafter.

Ensuring your comfort:

Just before you leave your room, empty your bladder so you will be comfortable during the procedure. At this time, your nurse will give you some medication to help you relax. The following two preparatory steps are typically done at this time, but may sometimes be done after you are brought to the catheterization laboratory:

• An intravenous (IV) needle and tube will be placed in the vein in your hand or arm before the procedure. Fluids or medications can be given quickly and easily through this tube if they are needed.
• Your nurse will make marks on your hands and feet where your pulse can be felt. These marks make it easier to check your circulation during and after the procedure.

Your procedure will be performed in a catheterization laboratory or a special procedure radiology suite. This room may be similar to the one where you had your diagnostic angiogram. You will lie on an x-ray table, and an x-ray camera will move over your chest during the procedure. The staff will monitor your heart by attaching several small, sticky patches to your chest and use a specialized ECG recorder and monitor.

Preparing Your Skin:
The area where the catheters are to be inserted, either your groin, arm or wrist, will be shaved and scrubbed with antiseptic solution to prevent infection. You will then be covered with sterile sheets.
Before starting the procedure your doctor will inject a local anesthetic (numbing medicine) where the catheters will be inserted. You may feel a stinging sensation as he or she does this. However, after the medication takes effect, you should only feel dull pressure where the physician is working with the catheters. If you do feel pain, please tell your doctor.

Inserting the Guiding Catheter:
Your doctor will choose to insert your guiding catheter in one of three spots:

Groin/Femoral Approach:
Catheter introduction into the groin requires a small incision to be made on the inside of your upper thigh so an introducer sheath (short tube) can be inserted into your femoral artery. Next, your doctor will insert a guiding catheter (long, flexible tube) into the introducer sheath and advance it through the aorta to where the coronary arteries branch off to the heart or affected peripheral artery.

Arm/Brachial Approach:
Catheter introduction into the arm requires that a small incision be made on the inside of your elbow after local anesthesia has been given. The guiding catheter is then inserted directly into the artery through the small incision and advanced to where the coronary arteries branch off to the heart or the affected peripheral artery.

Transradial Approach:
Catheter introduction into the wrist requires that a small incision be made on the inside of your wrist after local anesthesia has been given. The guiding catheter is then inserted directly into the artery through the small incision and advanced to where the coronary arteries branch off to the heart or affected peripheral artery.

Injecting the Dye:
After the catheters are inserted, your doctor will inject x-ray dye through the guiding catheter into your artery to look at the narrowing. Your doctor will watch this injection on an x-ray monitor, much like a TV screen. You may be able to watch these pictures yourself. While these x-rays are being taken, your doctor may ask you to take a deep breath and hold it for a few seconds. You may also be asked to cough after the x-ray picture is completed to help speed the removal of the x-ray dye from the arteries.

You will be awake during your procedure. From time to time, your doctor or a staff member may give you instructions. It is important to listen for these instructions and to do what is asked.

Directional coronary atherectomy (DCA) is a technique that allows the selective cutting and retrieval of atherosclerotic lesions (plaque) from coronary arteries. The removal of this tissue is commonly referred to as debulking.

The directional coronary atherectomy device is a catheter with a small mechanically driven cutter that shaves the plaque and stores it in a collection chamber. The plaque is then removed from the artery when the device is withdrawn.

The atherectomy procedure includes five main steps:

The cutter is positioned in the direction of the plaque. This directional control is of particular benefit when there is disease in only some portion of the vessel.
A balloon on one side of the catheter tip is inflated, causing the plaque on the opposite wall of the artery to protrude into the window of the cutting device.
The rotating cutter shaves off this portion of the plaque, which is then stored in the collection chamber of the catheter.
If there is additional plaque, the cutter can be repositioned and the same process applied.

Once sufficient debulking has been accomplished, your doctor may decide to perform angioplasty or other adjunctive therapies following the DCA procedure.

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