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Coronary Rotational Atherectomy


Rotational atherectomy is a procedure during which the plaque in your coronary arteries is ground into minuscule particles, which your body cleans from the bloodstream.

During the procedure, the physicians use a special catheter which has a burr on its tip. The burr is made of metal, and is eggshaped. Its leading edge is covered with tiny diamond chips. This catheter is called a "Rotablator."

The Rotablator burr rotates between 140,000 and 200,000 times per minute (rpm). The rotating burr breaks up the plaque and ablates (destroys) it.

Why has my doctor ordered this procedure for me?
The plaque in your coronary arteries may contain hardened deposits of calcium (calcification). If so, 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.

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.

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.

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.

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.

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

What happens before I'm discharged from the hospital?
From this point on, the process is the same as for balloon angioplasty.

 

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