Directional Coronary Atherectomy (DCA) is a minimally invasive procedure to remove the blockage from the coronary arteries and allow more blood to flow to the heart muscle and ease the pain caused by blockages.
The procedure begins with the doctor injecting some local anesthesia into the groin area and putting a needle into the femoral artery, the blood vessel that runs down the leg. A guide wire is placed through the needle and the needle is removed. An introducer is then placed over the guide wire, after which the wire is removed. A different sized guide wire is put in its place.
Next, a long narrow tube called a diagnostic catheter is advanced through the introducer over the guide wire, into the blood vessel. This catheter is then guided to the aorta and the guide wire is removed. Once the catheter is placed in the opening or ostium of one of the coronary arteries, the doctor injects dye and takes an x-ray.
If a treatable blockage is noted, the first catheter is exchanged for a guiding catheter. Once the guiding catheter is in place, a guide wire is advanced across the blockage, then a catheter designed for lesion cutting is advanced across the blockage site. A low-pressure balloon, which is attached to the catheter adjacent to the cutter, is inflated such that the lesion material is exposed to the cutter.
The cutter spins, cutting away pieces of the blockage. These lesion pieces are stored in a section of the catheter called a nosecone, and removed after the intervention is complete. Together with rotation of the catheter, the balloon can be deflated and re-inflated to cut the blockage in any direction, allowing for uniform debulking.
A device called a stent may be placed within the coronary artery to keep the vessel open. After the intervention is completed the doctor injects contrast media and takes an x-ray to check for any change in the arteries. Following this, the catheter is removed and the procedure is completed.
Review Date 5/10/2019
Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.