Directional Coronary Atherectomy for Coronary Artery Disease: DCA Procedure Animation Video
Directional Coronary Atherectomy (DCA) is a minimally invasive procedure to remove the blockage from the coronary arteries and allow more blood to flow to the heart muscle and ease the pain caused by blockages.
The procedure begins with the doctor injecting some local anesthesia into the groin area and putting a needle into the femoral artery, the blood vessel that runs down the leg. A guide wire is placed through the needle and the needle is removed. An introducer is then placed over the guide wire, after which the wire is removed. A different sized guide wire is put in its place.
Next, a long narrow tube called a diagnostic catheter is advanced through the introducer over the guide wire, into the blood vessel. This catheter is then guided to the aorta and the guide wire is removed. Once the catheter is placed in the opening or ostium of one of the coronary arteries, the doctor injects dye and takes an x-ray.
If a treatable blockage is noted, the first catheter is exchanged for a guiding catheter. Once the guiding catheter is in place, a guide wire is advanced across the blockage, then a catheter designed for lesion cutting is advanced across the blockage site. A low-pressure balloon, which is attached to the catheter adjacent to the cutter, is inflated such that the lesion material is exposed to the cutter.
The cutter spins, cutting away pieces of the blockage. These lesion pieces are stored in a section of the catheter called a nosecone, and removed after the intervention is complete. Together with rotation of the catheter, the balloon can be deflated and re-inflated to cut the blockage in any direction, allowing for uniform debulking.
A device called a stent may be placed within the coronary artery to keep the vessel open. After the intervention is completed the doctor injects contrast media and takes an x-ray to check for any change in the arteries. Following this, the catheter is removed and the procedure is completed.
Atherectomy is a minimally invasive endovascular surgery technique for removing atherosclerosis from blood vessels within the body. It is an alternative to angioplasty for the treatment of peripheral artery disease, with no evidence of superiority to angioplasty. It has also been used to treat coronary artery disease, albeit ineffectively.
Uses: Atherectomy is used to treat narrowing in arteries caused by peripheral artery disease.
Technique: Unlike angioplasty and stents, which push plaque into the vessel wall, atherectomy cuts plaque from the wall of the artery. While atherectomy is usually employed to treat arteries it can be used in veins and vascular bypass grafts as well.
Atherectomy falls under the general category of percutaneous revascularization, which implies re-canalizing blocked vasculature via a needle puncture in the skin. The most common access point is near the groin through the common femoral artery (CFA). Other common places are the brachial artery, radial artery, popliteal artery, dorsalis pedis, and others.
There are four types of atherectomy devices: orbital, rotational, laser, and directional.
The decision to use which type of device is made by the interventionist, based on a number of factors. They include the type of lesion being treated, the physician's experience with each device, and interpretation of the devices' risks and effectiveness, based on a review of the medical literature.
Directional coronary atherectomy (DCA) was originally developed as a potential replacement for balloon angioplasty. The design of the catheter used to perform DCA offered several unique advantages. First, it was capable of removing obstructive atherosclerotic lesions. Thus rather than rearranging plaque within an artery as occurs with balloon angioplasty, the obstruction was relieved by reduction of the plaque mass. Second, certain lesions with characteristics unfavorable for balloon angioplasty appeared to be ideally suited for DCA. Since the atherectomy catheter had a cutting window that could be positioned rotationally as well as longitudinally within an artery, eccentric plaque could be removed selectively. Similar benefits were anticipated from lesions located at important coronary bifurcations, such as those involving the left anterior descending coronary artery and origin of the diagonal branch. Finally, tissue removed by DCA was available for analysis to expand our knowledge about coronary atherosclerosis. Samples of coronary atheroma could be examined grossly and microscopically and studied by immunohistochemistry.
Initially, the value of DCA was assessed by means of a large registry that catalogued acute and late clinical outcomes. When compared with a historical control, the results of DCA appeared comparable to or better than those achieved by balloon angioplasty. There was a sense that the incidence of serious coronary dissection and abrupt occlusion after DCA was less than that after balloon angioplasty.
Watch video Directional Coronary Atherectomy for Coronary Artery Disease: DCA Procedure Animation Video online without registration, duration hours minute second in high quality. This video was added by user AniMed 03 March 2016, don't forget to share it with your friends and acquaintances, it has been viewed on our site 14,81 once and liked it 6 people.