An atherectomy is a minimally invasive procedure that removes plaque buildup from the arteries and reduces symptoms of arterial disease. It can only be used in certain situations, but when successful, it can improve blood flow and reduce the risk of coronary artery disease and peripheral artery disease.

When plaque builds up in an artery, the space for blood to flow narrows — a condition known as atherosclerosis. The artery itself becomes stiffer and less able to expand (dilate) to supply blood to muscles. Over time, plaque can block blood flow altogether or rupture and cause a dangerous blood clot.

Atherosclerosis is also a risk factor for high blood pressure, kidney disease, stroke, and other complications.

An atherectomy is a minimally invasive procedure that removes arterial plaque. It involves the cutting away of plaque, often with a drill-like tool. There are four types of atherectomy, depending on the device used:

  • Rotational atherectomy: Small blades moving in a circular motion cut away plaque.
  • Laser atherectomy: High intensity laser light vaporizes plaque blockages.
  • Orbital atherectomy: A spinning tool moves in a grinding style to remove plaque.
  • Directional atherectomy: A blade shaves plaque in one direction.

Atherectomy can only be used in certain situations, but when it’s successful, it can improve blood flow and reduce the risk of coronary artery disease and peripheral artery disease.

Atherectomy can often relieve symptoms of coronary artery disease (CAD) or peripheral artery disease (PAD) without surgery. You may be a good candidate for an atherectomy if you’re experiencing:

  • CAD symptoms:
    • angina (pain, tightness, or a heavy sensation in the chest)
    • shortness of breath
    • dizziness
    • pain in the arms or shoulders
  • PAD symptoms:
    • muscle pain and numbness in the lower limbs
    • calf pain while walking that goes away with rest
    • sores or cuts on the legs or feet that have trouble healing

These symptoms indicate arterial plaque buildup, which atherectomy may relieve.

Arterial plaque is made of cholesterol, fats, cellular waste products, calcium, and other substances. Atherectomy is very helpful in treating hard, calcified plaques. These plaques are less likely to rupture and cause a blood clot, as opposed to soft plaques.

Atherectomy is sometimes also helpful for individuals with ongoing circulation issues after angioplasty. And it can be useful in treating blockages that develop where an artery branches off into two separate blood vessels.

An atherectomy takes about 2 hours to perform, but there are some important steps that have to be taken before and after the procedure to lower the risk of complications and to help ensure a positive outcome.

Before the procedure

Before considering atherectomy, your doctor will have likely performed a vascular ultrasound, an angiography, or both tests. These tests can help pinpoint the location and size of a plaque blockage.

A vascular ultrasound uses sound waves to create images of the blood flow through your arteries and veins.

During an angiography, a healthcare professional injects a special dye into the bloodstream that can reveal details about the inside (lumen) of blood vessels and chambers of the heart. Angiography can be done in two ways:

  • Traditional or catheter-based angiography is done either before or at the beginning of an atherectomy. This is an invasive procedure where a contrast dye is injected into the artery in question.
  • CT angiography (CTA) can be done beforehand. This is a less invasive method using CT technology and contrast injection through a standard intravenous (IV) line.

You will also get instructions about eating, drinking fluids, and taking medications, such as anticoagulants, in the days and hours leading up to the procedure.

During the procedure

An atherectomy is usually performed in a hybrid operating room, which serves as a catheterization (cath) lab and an operating room for procedures like heart bypass surgery. You’ll be mildly sedated and given a local anesthetic in the area where the incision will be made.

Atherectomy is one of many tools available for these types of procedures. Sometimes your surgeon will combine various tools, such as angioplasty balloons or stents, depending on the information gained during the procedure.

Typical procedural steps:

  • A catheter is inserted into your artery through a small incision, either in your groin, upper thigh, arm, or wrist.
  • Contrast dye is injected to locate and see the narrowing.
  • Based on the narrowing, a decision is made about which device is best to use.
  • The tip of the catheter is fitted with a small laser or a rotating blade to cut or “sand” away sections of plaque.
  • Your doctor guides the catheter through your arteries to the site of the blockage.
  • The blade or laser scrapes or sands away the plaque. More than one pass through the artery may be needed to remove enough plaque. Many of the devices include a capsule to trap the plaque that’s been removed.
  • When the plaque has been sliced, sanded, or burned away, the catheter containing the excess plaque is removed, and the incision is closed.

You likely will not feel any pain during the procedure, but you may feel some pressure where the device is actively removing plaque.

After the procedure

The initial recovery can take up to 6 hours. During this time, you’ll need to lie flat to prevent bleeding complications. In some cases, this means having to spend the night in the hospital.

You will be monitored constantly to check for any changes in blood pressure or pulse rate, as well as any complications. Another angiography may be performed to check for improved blood flow.

You’ll probably be able to resume driving and other everyday activities within several days. But the location of the procedure and your overall health will determine a more accurate recovery timeline.

Your doctor may prescribe additional blood thinners after your atherectomy. It’s very important to follow these medication instructions precisely. Your doctor will also provide more details about what’s safe for you to do in the days or weeks after your procedure.

Atherectomy safely helps clear away calcified plaque and keeps blood vessels open, easing painful symptoms.

A 2020 study suggests that orbital atherectomy (which sands down plaque) effectively opens up blocked leg arteries 90 percent of the time, while laser atherectomy achieves similarly improved blood flow 76 percent of the time.

Another report suggests that improvements in rotational atherectomy — which uses blades to cut away plaque —during the past 30 years have greatly improved the effectiveness and safety of this procedure.

In some cases, an atherectomy can help an individual avoid major surgery and the long recovery that a more invasive procedure requires.

But atherectomy is only one tool in a surgeon’s selection of options. It can be very useful in areas that are not ideal for angioplasty, but each situation is different. Your doctor can help determine the best treatment method.

Because atherectomy is a slightly invasive procedure, there are some risks.

One main concern is that a small piece of plaque can break free and become stuck in a blood vessel, potentially causing a blood clot.

Another risk is that the atherectomy device itself can cause a tear in the artery lining. This could lead to bleeding complications that may require additional procedures to treat.

Research suggests that the risk of a heart attack following an atherectomy is about 1.3 percent, and the risk of dissection (tear in the inner wall of an artery) is about 10 percent.

However, when the procedure is used appropriately in the right patients with the right type of arterial plaque, the risk of complications is low.

Atherectomy and angioplasty are two methods of clearing away plaque for better blood flow through an artery. Both procedures use catheters to reach blockage areas in a blood vessel.

With angioplasty, a small balloon is fitted to the tip of the catheter and inflated at the blockage site. The balloon pushes the plaque against the wall of the artery and widens the space for blood to flow. The balloon is then deflated, and the catheter is withdrawn. In many cases, angioplasty is accompanied by the placement of a stent at the site of the blockage to help keep the artery open.

With atherectomy, the goal is to actually remove plaque by cutting, sanding, or using a laser. Sometimes atherectomy is followed by stent placement. Because it’s a more aggressive treatment, atherectomy poses more risks than angioplasty.

One study suggests that there are greater long-term risks associated with atherectomy than with angioplasty and stenting for people with PAD. But other researchsuggests that there’s no discernible difference between angioplasty and atherectomy outcomes in treating PAD.

An atherectomy can result in better circulation and reduced symptoms of atherosclerosis. Atherectomy devices are some of many tools doctors can use to help open up blocked blood vessels.

However, it is only safe and effective if the plaque is calcified and unlikely to lead to a blood clot and further blockage.

If your doctor suggests atherectomy to remove arterial plaque, ask why it would be the best approach and whether alternative treatments should be considered. And if you undergo an atherectomy, be sure to follow your doctor’s recommendations carefully to help avoid any serious complications.