atherectomie

Atherectomy, sometimes referred to as athérectomie in other languages, is an endovascular procedure aimed at removing atherosclerotic plaque from arteries to restore or improve blood flow. It uses catheter-based devices that cut, shave, sand, or vaporize plaque, or modify plaque to allow subsequent balloon angioplasty or stenting.

Device categories include directional atherectomy, rotational atherectomy, orbital atherectomy, and laser atherectomy. Directional atherectomy uses a cutting head to shave plaque from the vessel wall. Rotational atherectomy employs a high-speed burr to ablate plaque, particularly calcified lesions. Orbital atherectomy uses a rotating crown that sands plaque as it orbits within the artery. Laser atherectomy delivers laser energy to disrupt plaque. Some systems are used as standalone debulking tools, while others serve as adjuncts to angioplasty.

Indications span peripheral artery disease in the limbs and select coronary artery disease cases where plaques are calcified or resistant to conventional balloon angioplasty. It may be considered for complex lesions, heavily calcified vessels, or in-stent restenosis, though many centers reserve it for specific anatomies. The procedure is typically performed via femoral or radial artery access, with advancement of the device to the target lesion, followed by plaque modification and subsequent balloon angioplasty and often stenting.

Outcomes and risks vary by lesion type and technique. Atherectomy can improve luminal gain and facilitate device delivery in certain lesions, but it does not universally reduce restenosis and carries risks such as distal embolization, vessel perforation, dissection, and contrast-associated nephropathy. The procedure is performed by interventional cardiologists or vascular surgeons in specialized centers.