Rotational Atherectomy: Procedure, Equipment and Technique

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Rotablation, also known as rotational atherectomy, is a complicated procedure that requires a complicated technique with bulky calcification within the coronary arteries to insert stents in the arteries to improve blood flow. This procedure is also done to remove any form of plague that’s deposited within the arteries. 

If there is a serious blockage in arteries, the blood will not flow properly and it could increase the risk of blood clots or completely block the artery. Hence, it may lead to a heart attack. Therefore, rotational atherectomy is done to clear the blocked arteries. The rotational atherectomy is essentially a drilling technique done using a diamond top burr that rotates at a high speed of around 150,000 to 200,000 rotations/minute. 

This technique is done to clear the arteries from inside while allowing the stent to get into the arteries with ease. Well-trained and experienced interventional cardiologists perform this procedure carefully in certain medical conditions. Even though this particular procedure is risky, the trained surgeons know how to reduce the risk by following the best possible medical treatment.  

This procedure is usually done in the best cardiology hospitals in India by senior cardiologists to ensure there’s no risk involved during the treatment. 

How is an Atherectomy Performed?

The rotational atherectomy is generally performed in the cardiac catheterization laboratory. Just before this procedure, the patient is given sedatives to help him/her relax. After that, the catheter is gently inserted into the artery in the groin area or the upper thigh. This device is further guided through the blood vessel in the direction of the heart. 

When it is in the right position, dye is injected via the catheter into the coronary arteries. The X-ray is taken after that to help the doctor to see the area that’s narrowed or blocked. The physician further uses a laser or tiny blades, fixed at the end of the catheter, for vaporizing or cutting away the plaque. 

Soon after the atherectomy, sometimes rotablation angioplasty is also performed. After the treatment, the catheter is removed and patients are allowed to go home after 24 hours. 

You are a good candidate for the procedure of coronary atherectomy, if:

  • You had a heart attack.
  • You have chest pain or angina and shortness of breath, along with moderate or mild exertion.  
  • You have narrowed or closed the coronary bypass graft.
  • Your doctor identifies the plaque that can disrupt the blood flow. 
  • You have just one or two narrowed or blocked coronary arteries. If there are more coronary arteries with this condition, the doctor may suggest bypass grafting rather than atherectomy.
  • Your condition is not getting better with medications. 
  • Your symptoms are interfering with routine activities. 

Who Performs Rotational Atherectomy?

The following heart specialists perform rotational atherectomy: 

  • Interventional cardiologists specialize in treating heart conditions using a catheter and radiological imaging. 
  • Cardiologists specialize in treating heart conditions and blood vessels. 
  • Cardiac surgeons specialize in treating heart conditions with surgical methods.  

What to Expect at the Time of this Procedure? 

The skin in the groin region is usually numbed with a local anaesthetic. As an ideal entry point, a tube is placed into the artery. This stage is unpleasantly uncomfortable, but not to an extent of becoming unbearable. 

During the operation, you are given the necessary medication to keep you safe. While you will be conscious of local anaesthesia, your doctor will work to provide you with comfort. Throughout the process, a team of cardiac specialists will interact with you to assure that you are mindful and relaxed about what is going on. 

Will I Feel Pain During the Procedure?

The relaxation and comfort of a patient are of utmost importance to doctors. However, you are likely to feel a bit of pain during IV placement. There is also a brief stinging sensation at the time of injection of the local anaesthetic. You can even feel the pressure when the doctor inserts a catheter or makes an incision. There is also some discomfort in the chest at the time of the procedure. 

You must inform the doctor about any discomfort during the treatment, even if there’s minor discomfort. You will require more sedatives for keeping you comfortable and relaxed during the procedure. 

What to Do After the Completion of Procedure

For the first seven days, avoid any heavy lifting (not more than ten pounds), pushing, and straining or impact exercises (like jogging, cycling and running). You can walk, drive and even climb stairs if the punctured site does not have extreme bleeding, pain or swelling. Also, refrain from getting into the hot tub or bathtub until the punctured area heals fully. 

With a dressing on the puncturing spot, you’ll be discharged thereafter. This dressing could be taken out the next day. It is recommended to keep inspecting the punctured site for the first few days. If there are any major changes, report to your doctor. There may be some swelling or bruising in the area. But if you detect excessive swelling, bleeding or bruising, apply continuous pressure to the affected area and immediately seek medical help. 

Conclusion

If there is any health condition due to blocked or plagued arteries, your doctor will recommend rotational atherectomy. This procedure is minimally invasive. You need to follow all the aforementioned things during and after the treatment. However, if there are any unwanted problems like pain, swelling, vomiting, etc. after the procedure, you must consult your doctor right away.

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