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Directional coronary atherectomy (DCA)

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DCA, or directional coronary atherectomy is a minimally invasive procedure to remove blockage from coronary arteries to improve blood flow to the heart muscle and ease pain.

First, a local anesthesia numbs the groin area. Then the doctor puts a needle into the femoral artery, the artery that runs down the leg. The doctor inserts a guide wire through the needle and then removes the needle. He replaces it with an introducer, a tubular instrument with two ports used to insert flexible devices such as a catheter into a blood vessel. Once the introducer is in place, the original guidewire is replaced by a finer wire. This new wire is used to insert a diagnostic catheter, a long flexible tube, into the artery and guide it to the heart. The doctor then removes the second wire.

With the catheter at the opening of one of the coronary arteries, the doctor injects dye and takes an X-ray. If it shows a treatable blockage, the doctor uses another guide wire to remove the first catheter and replace it with a guiding catheter. Then the wire that was used to do this is removed and replaced by a finer wire that is advanced across the blockage.

Another catheter designed for lesion cutting is also advanced across the blockage site. A low-pressure balloon attached next to the cutter, is inflated, exposing lesion material to the cutter.

A drive unit is turned on, causing the cutter to spin. The doctor advances a lever on the drive unit that in turn advances the cutter. The pieces of blockage it cuts away are stored in a section of the catheter called a nosecone until they are removed at the end of the procedure.

Rotating the catheter while inflating and deflating the balloon makes it possible to cut the blockage in any direction, leading to uniform debulking. A stent may also be placed. This is a latticed metal scaffold put inside the coronary artery to keep the vessel open.

After the procedure, the doctor injects dye and takes an X-ray to check for change in the arteries. Then the catheter is removed and the procedure is over.

Review Date 9/7/2021

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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