Rotablation

What is coronary artery rotablation?

Rotational atherectomy, also known as rotablation, is an invasive manipulation that involves destroying/removing  hardened, calcified atherosclerotic plaques in the coronary arteries using a rotating device,  called a rotablator.

Atherosclerotic plaques, which form over time from a fatty substance composed of cholesterol, calcium, and other substances, accumulate in the coronary arteries and cause partial or complete blockage of the blood vessels. Due to impaired blood flow in the blocked or narrowed vessel, the oxygen supply to the heart muscle tissue is impaired, resulting in a heart attack (ischemia, angina or infarction). If the atherosclerotic plaque is soft enough, the patient usually undergoes the standard procedure of inserting a stent into the narrowed area. However, there are rare cases where the atherosclerotic plaque is too hard, in which case a rotablation  device must be used.

Rotational atherectomy is performed using a small rotating tip that spins at high speed, removing the calcified narrowing in the coronary artery and helping to restore blood flow.

When is rotablation necessary?

Rotablation is prescribed by the patient's attending cardiologist for the following indications:

• If the patient's coronary arteries are significantly calcified, making it impossible to perform standard angioplasty with stenting
• If other methods of treatment are not suitable due to the patient's medical condition or anatomical features;
• If the patient has chronic occlusions in which the arteries are completely occluded and require special intervention.

How is the rotablation procedure performed?

As with coronary angiography or coronary stenting, the patient is given local anesthesia before the rotablation procedure, which means that the patient is conscious during the manipulation. During the procedure, the doctor injects a special contrast agent into the coronary arteries through a catheter placed in the artery of the wrist or thigh. This substance does not allow X-rays to pass through, which allows the doctor to study the anatomy and patency of the arteries. The doctor carefully inserts a rotablator, a thin tip burr, into the blocked artery, which, once in place, begins to rotate and remove/cut the calcified narrowing. Rotablation is usually followed by angioplasty with stenting to prevent the coronary artery from narrowing again.

What happens after the procedure?

After the procedure, the patient will have to lie down for several hours. His/her blood pressure, heart rate and other vital signs will be monitored. The length of time the patient stays in the hospital depends on their overall health and the severity of the disease. Afterward, the attending physician will provide instructions for further treatment and schedule a follow-up visit to monitor the progress and results of the procedure.

Possible complications

Like coronary stenting, rotablation is generally a low-risk procedure. Complications are rare, but as with any other interventions and procedures, there are rare complications, including very rare deaths. A patient who is discharged home should contact their doctor immediately if he/she experiences:

• Chest pain;
• Difficulty breathing;
• Bleeding, severe redness, or signs of infection at the catheter insertion site;
• Fever

Recommendations

After discharge from the clinic, it is recommended that the patient:

• Avoid physical activity - exercise, lifting heavy weights, housework requiring physical labor;
• Rest and drink plenty of water (in some cases, this recommendation changes);
• Follow the diet prescribed by the doctor;
• Strictly follow the medication regimen prescribed by your doctor;
• Make a follow-up appointment with the  doctor sometime after the procedure;
• Avoid tobacco and alcohol.