Invasive and surgical treatment is advised in case of severe blockage and ischemia. Techniques like angioplasty, atherectomy and endarterectomy employ mechanical methods to widen the arteries or remove plaque. Bypass surgeries for arteries involve the rerouting of blood flow by using grafts. The exact method to be used depends on the location and degree of blockage, as well as the accessibility of the blocked artery.
Angioplasty is a minimally invasive procedure used to open up clogged arteries in almost any part of the body. In balloon angioplasty, a small balloon is guided to the site of blockage, and inflated to compress the plaque and thus widen the artery.
A small incision is made in the groin or wrist, following the administration of local anesthesia. A balloon-tipped catheter (balloon catheter) is then inserted into an artery of the leg or arms. The balloon catheter is threaded to the blockage site under X-ray guidance. Once at the site of blockage, a dye may be inserted at the site so as to determine the exact location of the blockage. The balloon catheter is then positioned at the precise location, and the balloon is inflated. As a result the surrounding plaque gets compressed, thus widening the arterial lumen. The balloon is then deflated and removed along with the catheter.
This procedure is similar to balloon angioplasty, but involves the use of a small, expandable metallic mesh called ‘stent’, along with the balloon.
The stent is placed around the balloon in a compressed form, and this assembly is placed at the tip of a catheter. It is then guided to the site of blockage as done during a balloon angioplasty. When the balloon is inflated, the stent expands and compresses the plaque. The balloon is then deflated and removed, leaving behind the stent which acts as a support and helps to keep the artery open.
This is a minimally invasive procedure that involves the use of specialized catheters for mechanical removal of plaque from the arterial walls. The plaque is either scraped out or pulverized with the help of tiny blades. The design and working of these devices ensures that the arterial wall remains damage-free.
The catheter is inserted into an artery in the leg or arm, through an incision in the groin or wrist. It is then routed to the blockage site, and the plaque is mechanically scraped out. Depending on the type of device or catheter used, atherectomy procedures employed are:
» Directional: Here, the catheter has a scraping blade attached to it along with a low pressure balloon on the opposite side. Once at the blockage site the balloon is inflated, as a result of which the blade is pushed towards the plaque. The plaque is then scraped out, and the catheter is rotated to ensure complete plaque removal. The plaque fragments are collected in a chamber present at the tip of the device.
» Rotational: A rotational atherectomy catheter has small, diamond-tipped, rotating edges which disintegrate the plaque into microscopic fragments. These fragments flow through the circulatory system, and are removed from the body through normal waste-removal processes.
» Transluminal extraction: The catheter used in this procedure has two stainless steel, rotating blades attached to a hollow tube. At the site of blockage, the rotating blades grind the plaque, and the resultant fragments are collected into the hollow tube by vacuum suction.
» Laser: In this procedure, a laser-tipped catheter is used to vaporize the plaque. The resultant molecules are removed by the body via liver and kidneys.
This surgical procedure involves the manual removal of plaque from the affected artery. It is generally used in case of arteries that are easily accessible, and is more commonly used in the treatment of carotid artery blockages.
In this procedure, a general or regional anesthesia is administered, and an incision is made at an appropriate region of the skin, so as to view the affected artery. A tube called ‘shunt’ may be attached to temporarily reroute the blood flow that occurs through the blocked region. At the blockage site, the arterial wall is incised along the length of the artery, and the plaque is pulled out manually. Dead tissue, if any, is also removed. The artery is then stitched close, the shunt is removed, and the incision site on the body is stitched close.
Artery Bypass Surgery
Bypass surgeries for blocked arteries involve re-routing blood flow through the blocked portion, by using an artificial graft or a piece of healthy vein removed from some other part of the body, especially saphenous vein in the leg.
General or regional anesthesia is administered depending on the location of the blockage, and an incision is made at the part where the blocked artery is located. The artery is clamped at the proximal and distal ends of the blocked area, and a graft is sewn to replace the blocked section or create a path for the blood to flow around it. Normal blood flow through the newly created path is ensured, and the incision site is stitched close.
One or more of the treatment options may be employed in case of severe blockages. However, these medical procedures do not guarantee the non-occurrence of plaques. Hence, it is utmost essential to follow a healthy lifestyle in order to prevent the formation of plaques in newer regions.