INOVA HEALTH SYSTEM : TREATMENT OPTIONS : Directional Coronary Atherectomy (DCA)

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Directional Coronary Atherectomy (DCA)

What is a directional coronary atherectomy (DCA)?
A directional coronary atherectomy is a therapeutic coronary interventional procedure used to open blocked heart arteries and restore blood flow to the heart. It uses a catheter that is advanced into the heart artery. The end of the catheter has a small mechanically driven cutter that shaves off the plaque or cholesterol build-up and stores it in a collection chamber. The plaque is then removed from the artery when the device is withdrawn.

Atherocath

Image courtesy of Boston Scientific

What are the risks?
The risks of atherectomy are fairly low. The risks include all of the complications noted for cardiac catheterization, but some of the risks, specifically heart attack and emergency bypass surgery, are higher because atherectomy is a more complex procedure. In some patients the risk of a heart attack with atherectomy may be slightly higher than with angioplasty. The risks include injury or tearing of an artery, which can cause the artery to close, or bleeding around the heart. This is often successfully treated with continued angioplasty. Rarely, this is difficult to treat, and five percent of patients may have a heart attack and one percent may need emergency bypass surgery. A cardiac surgery team is available at the Inova Heart Center if needed. In three to five percent of patients, the procedure is unsuccessful because the catheter cannot be advanced to the blockage or the artery cannot be fully opened. This can occur when the artery is small, has calcium deposits, or has severe bends. Click here to read more about the Inova Heart Center's outcome indicators regarding angioplasty.

What are the benefits?
Atherectomy will open blocked arteries and improve blood flow to your heart. It relieves symptoms, improves exercise duration, and in some cases stops or prevents heart attacks. It may be more effective than medications in relieving symptoms in patients with a blockage in one artery. Following an angioplasty, many patients can stop or reduce their number of heart medications.

How effective is an atherectomy?
Atherectomy is initially successful in about 93% of patients. However, about one-third of patients will develop a recurrence of the blockage (called restenosis). This occurs because atherectomy shaves off the blockage within the artery. The healing process within the artery can cause an overgrowth of cells and other substances, which cause a recurrence of the blockage. Restenosis usually occurs during the first six months. Your doctor will follow you closely for a return of symptoms and may even perform an exercise stress test. If a blockage returns, you can be treated with medications, a second angioplasty or other interventional procedure, or possibly bypass surgery. Only about 25% of patients will need a repeat procedure.

It might seem that removing the blockage would reduce the chance of restenosis. However, several large studies show that atherectomy and angioplasty have similar rates of restenosis. Smaller, more recent, studies show that atherectomy reduces restenosis compared to angioplasty if performed by very experienced physicians.

Is atherectomy right for you?
Different types of blockages in heart arteries respond to different kinds of interventions. The directional atherectomy can be used to treat many types of blockages in large arteries. However, it is infrequently used now because it requires a large catheter and is a more complex procedure than angioplasty. For most patients, it does not seem to offer a benefit over angioplasty. Directional atherectomy may be useful in treating eccentric blockages that are located on one side of the artery or blockages at a branch point in the artery. Directional atherectomy is less commonly used in small arteries, in arteries with severe angles, or in arteries with heavy calcium deposits.