Swedish endovascular physicians were among the first in the United States to utilize laser atherectomy, which is used to remove enough plaque from a clogged artery to allow a balloon angioplasty to be performed. In this procedure, a laser attached to the tip of a thin, flexible catheter emits short pulses of ultraviolet light (as opposed to the infrared spectra in older laser technology) that removes plaque (deposits of fats, inflammatory cells, proteins and calcium material along the lining of arteries). To avoid damaging artery walls with the laser beam, patients are injected with tagged antibodies that attach to plaque molecules and “guide” the laser pulses to plaque molecules only.
This procedure utilizes a specially designed catheter to remove clots within blood vessels that are obstructing a patient’s peripheral arteries. It’s a process that creates a low-pressure zone in the region of a high-velocity jet. Here, direct high-pressure saline jets located at the tip of the catheter create this effect. The clot is drawn into this region and, because of the large pressure difference, it is then broken up by the powerful mixing forces. The small particles that result are suctioned through the same catheter and removed from the body.
Ultrasound Accelerated Thrombolysis
Swedish endovascular surgeons are among the nation’s leaders in ultrasound accelerated thrombolysis, which uses high-frequency, low-power ultrasound to speed up blood clot disintegration in patients with blood clots (deep-vein thrombosis) and blocked arteries. Drugs that are used to dissolve clots are first delivered to a clot through a catheter, and then the ultrasound is delivered through the same catheter to drive the drugs into the clot.
One unique feature of this procedure is that 99 percent of the ultrasound energy will penetrate valves in the veins and impact the hard-to-reach clots located behind them. This treatment takes less time than other, more traditional treatments, thereby reducing the potential for severe bleeding.
This catheter-based procedure is used to remove a portion of the plaque from a blocked or narrowed artery prior to balloon angioplasty and the insertion of a stent. It can open up an artery that has hard plaque and that might not open up with angioplasty alone.
CryoPlasty is a procedure nearly identical to standard balloon angioplasty: a catheter is inserted into the femoral artery through a small incision in the groin, a wire is guided through the catheter and across the arterial blockage, and a balloon is then inflated to compress the blockage and dilate the vessel. The difference is that during CryoPlasty, the balloon is inflated with nitrous oxide, which cools the vessel in the area of the balloon to minus 10 degrees Celsius. This cooling kills cells and prevents them from multiplying in the treated area and thereby causing future blockages. Also, by freezing the artery wall into place, CryoPlasty helps prevent the artery from renarrowing, which may occur after standard balloon angioplasty.
Cutting Balloon Angioplasty
This is a unique and specialized technique. At the tip of the catheter is a balloon with three to four tiny knife blades that create small cuts, spaced evenly around the inside of the vessel wall. These cuts become controlled tears that then allow a second, low-pressure balloon to stretch and dilate the vessel. Cutting balloon angioplasty may be used on patients whose arteries have reclosed after a previous procedure, or in cases where conventional angioplasty balloons can’t remedy the problem. The advantage of the cutting balloon is its ability to reduce vessel stretch and vessel injury by scoring the blood vessel longitudinally rather than causing an uncontrolled disruption of the plaque. The cutting balloon also dilates the target vessel with less force to decrease the risk of scarring that could cause the vessel to reclose at a future time.
Endovascular surgeons use embolization to close blood vessels that are doing more harm than good, and also in bleeding situations. A variety of materials may be utilized for this procedure – depending on whether the closing is to be temporary or permanent or whether the vessels being treated are large or small – though all materials are delivered through a catheter. This minimally invasive approach is primarily used to control or prevent abnormal bleeding (that might be caused, for example, by an injury), shut down the vessels that support a growing tumor, eliminate an arteriovenous malformation (an abnormal connection between an artery and a vein) or to plug the artery supplying an aneurysm within the brain. Catheter embolization may be used as the sole treatment or it could be combined with other treatments such as surgery or radiation.