Editing Angiogram (section)

== Atherectomy devices ==

* Ideally achieve patency without the need for stenting - especially useful for areas where stenting should be avoided (CFA, POPA behind knee)
* Types:
** Direction
*** Carbide cutting blade with a variable height and a plunger used to pack the atheroma into the nose cone
*** Cutting blade rotates at up to 8000rpm
*** Designed for treating severe calcification
** Rotational
*** Insert a small drill into the artery to fracture a plaque and create a smooth lumen
** Laser atherectomy

Thromboembolectomy

* Aspiration
** Simplest way to remove thrombus - aspirate it with a large catheter or sheath (Export, PriorityOne, Pronto)
** Risk of distal embolisation remains - thrombolytic drugs often used in combination
** Work better in smaller vessels (<6mm)
* Rheolytic
** Jet of saline ejected from the tip of the catheter and used to dissolve it
* Rotational
** Remove the thrombus by rotating the tip of the catheter

Intra-luminal devices to cross chronic total occlusions

* Can be difficult or impossible to cross the plaque or segment of poorly organised thrombus, which often has a fibrotic or calcified cap at both ends, due to an inability to generate enough axial force through the guidewire
* Devices such as Crosser, TruePath, Frontrunner XP can be used to assist

Re-entry devices

* Outback LTD Re-Entry System - penetrates the intimal flap, redirecting the guidewire from the subintimal plane to the true lumen
* Other devices for similar effects

Embolisation devices

* Used to treat bleeding, small aneurysms, fistulas or endoleaks
* Mechanical
** Coils
** Vascular plugs
* Particulates
** Polyvinyl alcohol
** Gelatin microspheres
* Liquid agents
** Absolute ethanol
** N-butyl cyanoacrylate