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The clinical approach to atherosclerotic disease has dramatically changed, thanks to the recent improvements in interventional revascularisation procedures.w1 The mechanical relief of arterial obstruction through the introduction of a catheter into the arterial system to alleviate symptoms and reduce ischaemia and to prevent necrosis has been applied to all the important arterial networks: carotid, coronary and peripheral arteries. Removing the plaque and thrombus through an endovascular catheter without a surgical operation has offered a unique opportunity to obtain and study the retrieved material and to make clinicopathological correlations, thus allowing a better understanding of the atherothrombotic phenomenon. The target of non-surgical percutaneous interventional procedures is to debulk obstructed arteries. This result can be achieved through different approaches and mechanisms.
Catheter-based procedures for revascularisation can be divided into two different groups according to the main mechanism responsible for restoration of blood flow.
The first group encompasses angioplasty and stenting, in which the mechanism involves stretching, fragmentation and squeezing of the plaques and thrombus; the plaque is crushed outwards against the arterial wall, while the arc of the circle by the arterial wall spared by the plaque lesions is over-stretched.
The second group encompasses directional, rotational and transluminal extraction catheter atherectomy, in which the mechanism of debulking is either cutting with retrieval or aspiration, or pulverisation/grinding followed by removal with embolisation of the material. With directional atherectomy the catheter tip is equipped with a bladed device that cuts away the plaque and stores the fragments collected by multiple cuts in a tiny container. Soft and non-calcified material is usually obtained with the application of such devices; during rotational atherectomy a rot ablator tip is guided to pulverise mainly calcified plaque and the ground up micro particles can travel through the circulatory system. With transluminal extraction atherectomy the catheter is equipped with …
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