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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/09/01 11:44:02」(JST)

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Atherectomy is a minimally invasive surgical method of removing, mainly, atherosclerosis from a large blood vessel within the body. Today, it is generally used to effectively treat ^[1] peripheral arterial disease of the lower extremities. It has also been used to treat coronary artery disease, albeit ineffectively.^[2]

Procedure

Unlike angioplasty and stents, which push plaque into the vessel wall, atherectomy involves removing the plaque burden within the vessel. Increasing the vessel lumen by removing the plaque burden improves downstream wound healing, reduces claudication and pushes amputation levels more distal. While atherectomy is usually employed to treat arteries it can be used in veins and vein 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). However, wire and catheter access can occur from wherever a doctor is willing to stick. Other common places are the brachial artery, radial artery, popliteal artery, dorsalis pedis, and others.

Advantages

The procedure is considered less invasive than endarterectomy, which involves the surgical cut down and removal of plaque from the inner wall of a diseased vessel.

The advantages of atherectomy when compared to endarterectomy include less procedure time, ease of use, faster patient recovery, decreased systemic complications, repeatability in light of new occlusions. It also serves as a chance for non-surgical candidates.

The advantages of atherectomy when compared to balloons (angioplasty) and stenting are less vessel barotrauma, no foreign object (stent metal) left in the body and leaving all future options open for the patient at the treated site.

Atherectomy devices

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.^[3]

Directional^[4]^[5]^[6]^[7]

References

^ Keeling WB, Shames ML, Stone PA, Armstrong PA, Johnson BL, Back MR, Bandyk DF (January 2007). "Plaque excision with the Silverhawk catheter: Early results in patients with claudication or critical limb ischemia". Journal of Vascular Surgery 45 (1): 25–32. doi:10.1016/j.jvs.2006.08.080.
^ Wasiak J, Law J, Watson P, Spinks A (December 2012). "Percutaneous transluminal rotational atherectomy for coronary artery disease". Cochrane Summaries.
^ "Use and abuse of atherectomy: where should it be used?". Semin Vasc Surg 21 (4): 204–9. December 2008. doi:10.1053/j.semvascsurg.2008.11.007. PMID 19073311.
^ http://www.cardiovascularbusiness.com/index.php?option=com_articles&view=article&id=20058:atherectomy-the-little-devices-that-could
^ http://www.jvir.org/article/S1051-0443%2807%2960391-1/abstract
^ http://www.jvascsurg.org/article/S0741-5214%2806%2901618-1/abstract
^ http://scholar.google.com/scholar?q=silverhawk&oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&um=1&ie=UTF-8&sa=N&hl=en&tab=ws

UpToDate Contents

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1. 冠動脈疾患のマネージメントにおける血行再建術専用デバイス specialized revascularization devices in the management of coronary heart disease
2. アテローム切除デバイスの冠動脈合併症 coronary complications of atheroablative devices
3. 再狭窄予防のための冠動脈内放射線治療の使用 use of intracoronary radiation to prevent restenosis
4. 冠動脈ステント再狭窄 intracoronary stent restenosis
5. 冠循環の血管内超音波、光干渉断層撮影、および血管内視鏡 intravascular ultrasound optical coherence tomography and angioscopy of coronary circulation

English Journal

GuideLiner, a child-in-a-mother catheter for successful retrieval of an entrapped rotablator burr.

Cunnington M, Egred M.SourceFreeman Hospital, Newcastle upon Tyne, United Kingdom.
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.Catheter Cardiovasc Interv.2012 Feb 1;79(2):271-3. doi: 10.1002/ccd.23032. Epub 2011 Jul 25.
Entrapment of the rotablator burr within heavily calcified lesions is a recognized complication, which usually necessitates sternotomy and open surgical intervention to retrieve the trapped burr. In some cases, the trapped burr can be retrieved using simple traction, but this is potentially hazardou
PMID 21793173

Surgical treatment for ellis type 3 coronary perforation during percutaneous catheter intervention.

Totsugawa T, Kuinose M, Yoshitaka H, Katayama K, Tsushima Y, Ishida A, Chikazawa G, Hiraoka A.SourceDepartment of Cardiovascular Surgery, The Sakakibara Heart Institute of Okayama.
Circulation journal : official journal of the Japanese Circulation Society.Circ J.2012;76(2):377-81. Epub 2011 Dec 1.
Background: Coronary perforation (CP) is a rare, but sometimes lethal, complication of percutaneous catheter intervention (PCI). We reviewed surgically-treated cases of type 3 CP during PCI. Methods and Results: From 2007 to 2010, 5 patients underwent surgical repair for type 3 CP (3 men, 2 women; m
PMID 22130316

Japanese Journal

Surgical Treatment for Ellis Type 3 Coronary Perforation During Percutaneous Catheter Intervention

TOTSUGAWA Toshinori,KUINOSE Masahiko,YOSHITAKA Hidenori,KATAYAMA Keijiro,TSUSHIMA Yoshimasa,ISHIDA Atsuhisa,CHIKAZAWA Genta,HIRAOKA Arudo
Circulation journal : official journal of the Japanese Circulation Society 76(2), 377-381, 2012-01-25
… Conclusions: CP induced by balloon inflation tends to result in a serious condition compared with rotablator-induced CP. …
NAID 10030035669

冠動脈インターベンション(PCI) 冠動脈インターベンションの種類ロータブレーター血管形成術 (冠動脈疾患(上)診断と治療の進歩) -- (冠動脈疾患における治療学の進歩)

三角和雄
日本臨床 69(-) (1006), 295-303, 2011-09
NAID 40018986187

Related Pictures

Rotablator http://www.mountsinai.org After Rotablator Therapy: ロータブレーター（Rotablator El tratamiento por placa rotablator se ou rotablator dans une IVA proximale Effect of Rotablator Atherectomy and Boston Scientific Rotablator System Rotablator | Peninsula Heart Centre

★リンクテーブル★

リンク元	「ロータブレーター」

「ロータブレーター」

Atherectomy
	Intervention
	Illustration of three types of atherectomy devices being used to remove plaque in a blood vessel
ICD-9-CM	39.50, 00.61 -00.62
MeSH	D017073

　　[★]

英: Rotablator

動脈壁に付着した粥腫を削り取るデバイス
ミクロダイヤモンドが埋め込まれた先端部Burrの高速回転により、理想的なDifferential Cuttingを実現。Rotablatorシステムは動脈壁の健常な組織を回避しながら、非弾性プラークを除去。

[1] Keeling WB, Shames ML, Stone PA, Armstrong PA, Johnson BL, Back MR, Bandyk DF (January 2007). "Plaque excision with the Silverhawk catheter: Early results in patients with claudication or critical limb ischemia". Journal of Vascular Surgery 45 (1): 25–32. doi:10.1016/j.jvs.2006.08.080.

[2] Wasiak J, Law J, Watson P, Spinks A (December 2012). "Percutaneous transluminal rotational atherectomy for coronary artery disease". Cochrane Summaries.

[3] "Use and abuse of atherectomy: where should it be used?". Semin Vasc Surg 21 (4): 204–9. December 2008. doi:10.1053/j.semvascsurg.2008.11.007. PMID 19073311.

[4] ttp://www.cardiovascularbusiness.com/index.php?option=com_articles&view=article&id=20058:atherectomy-the-little-devices-that-could

[5] ttp://www.jvir.org/article/S1051-0443%2807%2960391-1/abstract

[6] ttp://www.jvascsurg.org/article/S0741-5214%2806%2901618-1/abstract

[7] ttp://scholar.google.com/scholar?q=silverhawk&oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&um=1&ie=UTF-8&sa=N&hl=en&tab=ws

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案内

案内

Rotablator