Rotational atherectomy involves the use of a revolving instrument called a Rotablator to break up the plaque that is blocking a coronary artery. It is a special technique used along with percutaneous coronary intervention with a catheter for complex coronary artery disease.
The technique, delivery mechanism and results of the atherectomy are somewhat like an angioplasty. However, the atherectomy pulverizes and removes plaque from the blocked blood vessel wall while the angioplasty compresses the plaque in place against the blood vessel walls. An atherectomy is usually indicated when the plaque blockage is particularly hard or calcified or when blockage returns in a previously placed stent.
- Helps to expand coronary arteries blocked by a large amount of plaque where a balloon cannot be inserted and inflated or where a stent cannot be placed.
-Effective in severely calcified lesions
You will be given an anticoagulant to prevent blood clots. Other medications and fluids will be given through intravenous lines. A local anesthetic will be injected to numb the area of your body that is used (the groin, the wrist, or the inside of the elbow). A thin tube with a Rotablator will be guided into the narrowed or blocked artery to get rid of the fat or plaque there. Normal saline solution is also administered to the site at the same time to reduce the heat from the Rotablator. The other end of the catheter is attached to a fast rotating device that controls the Rotablator and turns at 150,000 to 160,000 rounds per minute (RPM). Each application of the Rotablator takes 15-20 seconds and will be repeated until the doctor is happy with the results. Then a balloon will be inserted and inflated and a stent placed to keep the artery open.
To allow for the most effective treatment, the patient’s health and disease must be assessed. The patient’s medical history is also important. The doctor will explain your medical condition, the reason for the procedure, and the risks and benefits of treatment. As this procedure is usually done with percutaneous coronary intervention, preparation for the procedure is the same as percutaneous coronary intervention. Before the procedure you will undergo a physical examination as well as several laboratory tests. Please let your medical team know if you have any allergies to medication, food, and other substances. Patients who take anticoagulants, such as aspirin, clopidogrel, prasugrel, etc., do not need to stop their medication, but those taking other blood thinners or certain diabetes medication, such as Metformin, will need to speak to the doctor for specific instructions. Fast for at least four hours before the procedure. Avoid drinking alcohol and smoking cigarettes for at least one week. On the day of the procedure, please bring all current medication with you to the hospital. The doctor may prescribe medication to help you relax and to prevent allergies to contrast.
After the procedure, you will be taken to a recovery area for observation and monitoring. It is important to lie flat for several hours to avoid bleeding. If the procedure was done at the groin, pressure may be placed at the site to prevent bleeding. If the catheter was inserted through the wrist, after the procedure you will be able to get up. A bandage will be placed at the insertion site. Depending on your condition, you will remain in the hospital for one or more days. Ask your health care team when you can shower, return to work, and resume other normal activities. Your puncture site will remain tender for a while. It may be slightly bruised and have a small bump. Your doctor will likely prescribe medications to prevent blood clots. It is important to follow your doctor’s instructions regarding the blood thinning medications. While this procedure will open blocked arteries, it will not cure coronary artery disease. It is up to you to be committed to living a heart-healthy lifestyle. You can make dietary changes, quit smoking, exercise regularly, keep your appointments, and be an active member in your treatment.
Artery dissection (10%) Abrupt vessel closure (1.8%) A slow-flow phenomenon (1.2-7.6%) Perforation (1.5%) Severe spasm of the blood vessel (1.6%) Myocardial infarction (1.2-1.3%) Emergency CABG (1-2.5%) Death (1%) Let your doctor know if you experience any symptoms such as: Chest pain Difficulty breathing Sweating Heart palpitations Dizziness, fainting
What are the travel restrictions that come before and after the procedure?
Before the procedure You should plan to stay in Thailand for at least one week through the duration of your treatment. It is recommended that you stay in a hotel close to the hospital for convenience in traveling to the hospital before and after the procedure or from the day of the procedure to the day of your follow-up appointment. After the procedure At your follow-up appointment you will undergo a physical examination and your wound will be checked. You will receive documentation regarding your surgery or procedure and all other relevant documentation for traveling. You will receive information about caring for yourself when you return home and be given the document “Discharge Instructions for Percutaneous Transluminal Coronary Angioplasty (PTCA)/Stent.” Please read all information you are given carefully and follow your medical team’s instructions. When traveling by air, if you are seated in Economy Class, please choose an exit row or bulkhead seat for convenience in getting up and moving around every 15-30 minutes. Flex your ankles regularly to prevent deep vein thrombosis. Please take all medication prescribed by your doctor. Carry the appropriate dosage of mediation in your carry-on luggage when you travel as well as a few extra doses in case of an emergency. Carry the prescription for all your medication to avoid problems at the airport.
What is the likelihood of success of this procedure?
When the artery deteriorates, plaque can be hidden in fat to collect in the walls of the artery, causing it to harden and narrow or leading to chronic total occlusions. The likelihood of success depends on the amount of plaque collected, which can be assessed through computed tomography scan (computed tomography coronary calcium scoring). If you have any questions, please talk to your doctor.
What if this procedure is not performed?
When the heart does not receive enough blood, it also doesn’t receive enough oxygen and nutrients to function properly. This can lead to loss of blood flow to the heart and a heart attack.
How does rotational atherectomy compare to other types of atherectomies such as directional and laser atherectomies?
Rotational atherectomy is used for particularly difficult or calcified blockages and is the preferred method of preparing a heavily blocked artery for stent placement. The device rotates at extremely high speed, up to 180,000 and as a result, breaks the plaque down to such a small size that it can pass through the bloodstream with no adverse effects. Directional coronary atherectomy involves a specially made minimally invasive device with a tiny cutting tip that rotates at high speed to cut away plaque in the artery. A small balloon dilates the blood vessel to improve the efficacy of the procedure and protect the vessel walls. The resected plaque is aspirated and removed from the bloodstream. A laser atherectomy employs a laser light beam in short bursts to vaporize the plaque build-up within the artery. It is often employed for previously failed interventions and when the plaque build-up is not heavily calcified.