Rotational Atherectomy

1) What is Rotational Athrectomy/Rotablation?

A rotational atherectomy is a type of percutaneous coronary intervention (PCI) that uses a revolving instrument to break up calcified plaque clogging a coronary artery in order to restore blood flow to the heart.Rotational atherectomy uses a tiny rotating cutting blade to open a narrowed artery and improve blood flow to or from the heart. Often a stent—a small tube made of metal mesh—is put in the artery to prevent it from re-narrowing

2) What does rotational atherectomy involve?
With the patient awake and under local pain medicine, the doctor inserts a thin, flexible tube (catheter) in an artery, usually near the patient's groin. Using an X-ray camera, the doctor guides the catheter to the site of the narrowed artery.The doctor then injects a harmless dye into the artery, and takes an angiogram, or picture of the artery. This helps the doctor see the exact size and place of the blockage.
Using a guidewire, the doctor threads another catheter to the site of the blockage. This catheter has a small, rotating, diamond-tipped burr at its tip, which grinds away the arterial plaque. The plaque then moves through the circulatory system and out of the body.
In many cases, the doctor places a narrow metal tube, or stent, inside the artery to keep it from closing. Newer drug-eluting stents slowly release medication that help keep the blood vessel from reclosing. At times, a doctor will use a distal protection device—a kind of filter—to block loosened fatty deposits from entering the bloodstream.

3) How long is the recovery after a rotational atherectomy?
Patients often can walk within six hours after the procedure. Most patients spend the night in the hospital, return home within a day or two, and go back to work within a few days.
Patients with stents should not do strong exercise for 30 days. They will also take blood-thinning medication the rest of their lives.
In about 40 percent of patients (20 percent of those with stents), the opened artery narrows again within six months after the procedure. These patients may need another angioplasty, or coronary artery bypass surgery.

4) When is this procedure done?
When the plaque in your coronary arteries contains hardened deposits of calcium (calcification) that cannot be treated with ease. In such cases, angioplasty may not work, because the balloons cannot compress the plaque against the arterial walls. Rotational atherectomy removes some of the plaque. Sometimes, balloon angioplasty is performed after rotational atherectomy to compress any remaining plaque. Often, the rotational atherectomy alone, can widen the lumen sufficiently for adequate blood flow.

5) Are there any risks associated with this procedure?
The risks of rotational atherectomy are fairly low. They include the same risks as balloon angioplasty, as well as heat-produced damage to the arterial walls, temporary slow blood flow, and most rarely, temporary impaired blood flow down the artery. This can generally be corrected with medicines in the catheterization laboratory before the procedure is completed.

6) Is there anyone who should not have this procedure?
Rotational atherectomy is not recommended for people who have very poor functioning of the left ventricle (heart's main pumping chamber). If you have already undergone coronary bypass surgery and you have restenosis in your graft vessel, this procedure may not be recommended for you. The decision will be based upon the type and condition of your graft vessel.

7) What preparations should I make before the procedure?
The preparations are similar to those made for the coronary angioplasty procedure. You may be given some medications and aspirin 24 hours prior to the procedure.

8) What happens during the procedure?
The procedure resembles coronary angioplasty up until the point after the guiding catheters are inserted. After these are in place, and guiding pictures have been taken to confirm the sites of the plaque, you will be given some intravenous medications. Then a solution will be flushed through the Rotablator®. The rotation system is first tested outside your body Then the is advanced through the guiding catheter and into the artery near the plaque. Contrast fluid is inserted to confirm blood flow. If blood flow is insufficient, different size burrs will be tested.
The operator will make the burr spin at a lower speed of145,000 to 160,000 rpm. Then the burr is advanced slowly. When the burr is at the site of the plaque, it will be spun at between 180,000 and 200,000 rpm. This process lasts no more than 15 to 20 seconds. Tests are performed and then the rotation process is repeated several times. During this time, you may feel some heat at the site of the rotation.
After the rotational atherectomy, the physicians will take additional angiograms to ascertain if there is still some narrowing of the lumen. If so, balloon angioplasty may be performed. Stents may be inserted, as well.

9) How long does the procedure take?
The procedure takes from one to three hours

10) What are the risks associated with Rotational Athrectomy?

  • Bleeding around the heart
  • Injury to artery
  • Tearing of artery
  • Heart attack
  • Emergency bybass
  • Unsuccessful surgery: catheter cannot be advanced to blockage because of severe calcium deposits and bends
  • No re-flow: the normal flow in the coronary arteries is not restored after the insertion of a device