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Abstract

An improved method of performing atherectomy on plaque material at a site within a vessel utilizing a directional atherectomy catheter with a cutter which has a marker such as a cutter window which is visualizable on fluoroscopy and which is used to direct cuts, and an ultrasonic imaging apparatus. The method includes positioning the catheter cutter with fluoroscopy such that the directional marker is perpendicular to the X-ray beam; making an initial reference cut in the plaque material in the vessel; utilizing the ultrasonic imaging apparatus locate the initial reference cut to orient the distribution of plaque with respect to the visualized position of the fluoroscopically visualized directional marker on the cutter so that subsequent cuts made with the cutter result in plaque removal in an area having a predetermined spatial relationship to the initial reference cut; performing a first series of organized cuts of said plaque including making one or more passes with the cutter in said area; ultrasonically visualizing said vessel to determine the remaining location of plaque after said first series of organized cuts; performing additional cuts in said area and ultrasonically visualizing the vessel until all of the plaque in the area is removed, or the amount removed is judged to be appropriate by the operator; followed by repeated additional cuts of said plaque at additional chosen areas and ultrasonic visualization thereof.

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First Claim