Rotational Atherectomy
What is a Rotational Atherectomy?
Rotational atherectomy is an advanced, minimally invasive procedure used to treat severely calcified coronary artery disease—a condition in which plaque buildup hardens into calcium deposits, making traditional treatments like balloon angioplasty and stenting less effective.
This specialized technique is typically recommended for patients whose arteries are too rigid or narrowed for standard interventions. It involves the use of a high-speed, diamond-tipped rotational burr, which gently grinds away hardened plaque inside the artery. By modifying the calcified blockage, the procedure makes it easier to place a stent and helps restore optimal blood flow to the heart muscle.
Rotational atherectomy is performed in a catheterization lab and plays a crucial role in enabling successful treatment of complex coronary lesions, ultimately supporting improved heart function and patient outcomes.
Benefits & Risks of a Rotational Atherectomy
Benefits
For patients with severe calcification in their arteries, rotational atherectomy offers significant benefits:
- Enhanced Stent Placement: Prepares the artery for optimal stent expansion by removing rigid calcium deposits.
- Minimally Invasive: Performed via a catheter inserted through the wrist or groin, requiring only a small incision.
- Improved Blood Flow: Helps restore circulation in cases where traditional balloon angioplasty alone would be ineffective.
- Reduced Risk of Complications: By carefully breaking down calcium, it reduces the risk of arterial damage during stent placement.
Risks
As with any medical procedure, there are some associated risks, including:
- Artery Injury: The procedure may cause small tears or damage to the artery walls, requiring additional intervention.
- Blood Clots or Embolization: Dislodged plaque particles can travel through the bloodstream, potentially leading to blockages in smaller arteries.
- Arrhythmias: Temporary irregular heartbeats can occur during or after the procedure but are usually manageable.
- Bleeding or Bruising: Mild to moderate bleeding at the catheter insertion site is common but typically resolves on its own.
- Restenosis: In some cases, the treated artery may narrow again over time, requiring further treatment.
What to Expect With a Rotational Atherectomy
Before the Procedure
- Your doctor will conduct imaging tests, such as coronary angiography, to assess arterial calcification.
- You may need to stop taking certain medications, such as blood thinners.
- Fasting for several hours before the procedure may be required.
- The access site (wrist or groin) will be prepped and numbed with a local anesthetic.
During the Procedure
- A catheter is inserted into the artery through a small incision.
- A high-speed rotating burr is guided to the blockage and used to gently grind away calcium deposits.
- Once the blockage is cleared, a balloon is inflated to widen the artery, and a stent is placed to keep it open.
- The catheter is removed, and a closure device or compression is applied to the access site.
After the Procedure
- Patients are monitored for a few hours and typically go home the same day or the next morning.
- Avoid strenuous activity and heavy lifting for a few days to allow the artery to heal.
- Mild bruising or discomfort at the access site is normal and should resolve quickly.
- Follow-up appointments will be scheduled to monitor stent function and overall heart health.
Am I a Candidate for a Rotational Atherectomy?
Rotational atherectomy may be recommended for patients who:
- Have severely calcified coronary artery disease that limits blood flow.
- Have previously attempted balloon angioplasty without success due to hard plaque buildup.
- Are undergoing a stent procedure but require additional plaque removal to ensure success.
- Have been advised by their Cardiologist that their condition requires an advanced interventional approach.
Your Interventional Cardiologist will determine if rotational atherectomy is the best option based on imaging studies and the severity of arterial calcification.